Addiction Counseling
Competencies:
The Knowledge, Skills, and
Attitudes of Professional Practice
Technical Assistance Publication Series
21
Addiction Technology Transfer Centers
National Curriculum Committee
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
Substance Abuse and Mental Health Services Administration
Rockwall II, 5600 Fishers Lane
Rockville, MD 20857
This publication was prepared under the Addiction Technology Transfer Centers
cooperative agreement from the Center for Substance Abuse Treatment (CSAT) of the
Substance Abuse and Mental Health Services Administration (SAMHSA). Susanne R.
Rohrer, CSAT, served as the Government project officer. All material appearing in this
volume is in the public domain and may be reproduced or copied without permission
from CSAT or the authors. Citation of the source is appreciated.
The opinions expressed herein are the views of the authors and do not
necessarily reflect the official position of CSAT or any other part of the U.S. Department
of Health and Human Services (DHHS).
DHHS Publication No. (SMA)98-3171
Printed 1998
National Curriculum Committee
T ABLE OF C ONTENTS
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Section 1:
Transdisciplinary Foundations . . . . . . . . . . . 11
Introduction to the Transdisciplinary Foundations . . . . . . . 11
I.
Transdisciplinary Foundations
A. Understanding Addiction .
B. Treatment Knowledge . .
C. Application to Practice . .
D. Professional Readiness .
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Section 2: The Professional Practice of
Addiction Counseling . . . . . . . . . . . . . . . 24
Introduction to the Professional
Practice of Addiction Counseling . . . . . . . . . . . . . . . . 27
I.
Clinical Evaluation . . . . . . . . . . . . . . . . . . . .
A. Screening . . . . . . . . . . . . . . . . . . . . . . .
B. Assessment . . . . . . . . . . . . . . . . . . . . .
27
27
33
II.
Treatment Planning . . . . . . . . . . . . . . . . . . .
36
III.
Referral . . . . . . . . . . . . . . . . . . . . . . . . .
43
IV.
Service Coordination . . . . . . . . . . . . . . . . . . .
A. Implementing the Treatment Plan . . . . . . . . . . .
B. Consulting . . . . . . . . . . . . . . . . . . . . . . .
C. Continuing Assessment
and Treatment Planning . . . . . . . . . . . . . . .
49
49
54
Addiction Counseling Competencies
57
i
Addiction Technology Transfer Program
V.
Counseling . . . . . . . . . . . . . . . . . . .63
A. Individual Counseling . . . . . . . . . . . . . . . 63
B. Group Counseling . . . . . . . . . . . . . . . . . 72
C. Counseling Families, Couples,
and Significant Others . . . . . . . . . . . . . . 76
VI.
Client, Family, and
Community Education . . . . . . . . . . . . . . . .
VII.
80
Documentation . . . . . . . . . . . . . . . . . 85
VIII. Professional and
Ethical Responsibilities . . . . . . . . . . . . . . . . 90
Appendix A – References . . . . . . . . . . . . . . . . . . . . . . 97
Appendix B – Glossary of Terms . . . . . . . . . . . . . . . . . . .103
Appendix C – Addiction Counseling Competencies . . . . . . . . . 107
ii
Table of Contents
National Curriculum Committee
PREFACE
This document presents the knowledge, skills, and attitudes that are needed for
achieving and practicing the competencies listed in Addiction Counseling
Competencies (included as Appendix C). The document is intended to provide
guidance for the professional treatment of substance use disorders which has become
recognized as a complex multidisciplinary practice supported by a large and rapidly
expanding body of theoretical and scientific literature. Both public and private research
initiatives have repeatedly demonstrated the cost effectiveness of well designed
strategies for intervening with people suffering from the adverse consequences of both
substance abuse and dependence.
As our understanding for how best to interrupt the destructive course of
substance abuse problems has grown, the parallel process of preparing treatment
professionals has also been developing. Addiction specialties have recently emerged
in medicine, nursing, and other allied health and human service professions. The
primary care givers, however, have traditionally been counselors who specialize in
chemical dependency treatment. Historically, those counselors have been trained in
specialty training programs often developed by treatment agencies rather than in
academic institutions. Today, due to a variety of policy and economic factors, the
preparation of substance abuse counselors is being undertaken by colleges in
cooperation with treatment agencies, where classroom and field training experiences
are being integrated into competency-based instructional programs.
In 1993 the Center for Substance Abuse Treatment (CSAT) created the
Addiction Technology Transfer Center (ATTC) Program, comprised of eleven
geographically dispersed centers covering twenty-four states and Puerto Rico, to foster
improvements in the preparation of addiction treatment professionals. As part of that
program the ATTC National Curriculum Committee (the Committee) was established to
evaluate existing curricula and establish priorities for curriculum development. The
Committee’s first activity was to define the competencies essential to the effective
practice of counseling for psychoactive substance use disorders. Those competencies
could then be used as criteria for evaluating curriculum materials.
In addition to its own original contribution, the Committee reviewed and
incorporated existing literature related to the work of the addiction counselor (Birch &
Davis, 1986; ICRC, 1991). The result of the Committee’s effort was the 1995
publication of Addiction Counselor Competencies. Subsequently, the ATTCs
conducted a national survey to validate the competencies. Results indicated broad
support for virtually all of the competencies as essential to the practice of addiction
counseling.
Addiction Counseling Competencies
1
Addiction Technology Transfer Program
The Committee then began the process of delineating the knowledge, skills, and
attitudes (KSAs) that make up each of the 121 competencies listed in the Addiction
Counselor Competencies. During the development of the KSAs, the Committee elicited
input from professional organizations including the International Certification
Reciprocity Consortium (ICRC), the National Association of Alcoholism and Drug Abuse
Counselors (NAADAC), the American Psychological Association, the National
Association of State Alcohol & Drug Abuse Directors, and the International Coalition of
Addiction Studies Educators (INCASE). Field reviewers also made significant
contributions to the final product that appears here.
Collaborative Effort
In November 1996, ICRC convened a meeting of representatives from a number
of national organizations, which represent the professional addiction counseling field,
to deliberate the need for model counselor training curricula. The group concluded that
much of the work to define such a curriculum standard had been completed by the
ATTC National Curriculum Committee and the ICRC. The work included a draft of
Addiction Counseling Competencies: The Knowledge, Skills, and Attitudes of
Professional Practice and the 1996 Role Delineation Study, respectively. Only a
modest amount of work remained to finalize a document that could be used as a
national standard. CSAT agreed to support an expanded collaborative effort and
convened a panel representing key educational, certification, and professional
associations to complete the work. This group is the National Steering Committee on
Addiction Counseling Standards. It is comprised of representatives from CSAT, the
ATTC National Curriculum Committee, ICRC, NAADAC, INCASE, and the American
Academy of Health Care Providers in the Addictive Disorders.
The National Steering Committee reviewed the 1996 ICRC Role Delineation
Study and a draft of the Addiction Counseling Competencies: The Knowledge, Skills,
and Attitudes of Professional Practice (1997). It determined that with minor
modifications, the Addiction Counseling Competencies: The Knowledge, Skills, and
Attitudes of Professional Practice document includes the essential knowledge, skills,
and attitudes requisite to effective addiction counseling practice. The National Steering
Committee endorses and promotes the Addiction Counseling Competencies: The
Knowledge, Skills, and Attitudes of Professional Practice document as a vehicle for
counselor development and curriculum planning for both pre-service and continuing
education. It is a dynamic document that will continue to evolve as addiction science
and technology progress.
2
Preface
National Curriculum Committee
INTRODUCTION
Every day, countless lives are enriched or saved because of the work carried out
by addiction counselors. In a myriad of settings, competent, well-trained counselors
form the relationships and carry out the strategies that help their clients move from lifethreatening addiction to life-affirming recovery. Although the field of addictions can be
very broad in scope, we have chosen to focus on the work of counselors who deal with
psychoactive substance use, abuse, and dependence among their clients.
We can state with certainty that thousands of addiction counselors accomplish
their missions with distinction. We also know, however, that even specialists in the
addictions field have not traditionally been able to define with clarity the professional
standards that should guide their work. What is the scope of practice that is
appropriate for an addiction counselor? What are the competencies that are most
likely to be associated with positive outcomes? What knowledge, skills, and attitudes
should be shared by all members of the addiction counseling profession? The central
purpose of this publication is to address those questions.
Transdisciplinary Foundations
The first section, Transdisciplinary Foundations for Addiction Professionals,
identifies the knowledge and attitudes that underlie competent practice not just for
counselors but for addiction specialists in other disciplines as well. Functional skills
may vary across disciplines, but the knowledge and attitudes highlighted here provide a
basis of understanding that should be common to all addictions professionals and that
serves as a prerequisite to the development of competency in each discipline. These
foundations, as articulated in Addiction Counseling Competencies (Appendix C),
include:
Understanding Addiction
Treatment Knowledge
Application to Practice
Professional Readiness.
Addiction Counseling Competencies
3
Addiction Technology Transfer Center Program
The Professional Practice of Addiction Counseling
The second section of the publication addresses the professional practice of
addiction counseling. The National Curriculum Committee of the Addiction Technology
Transfer Center program, which is supported by the Center for Substance Abuse
Treatment, developed this section over a three-year period. Using reviews of current
research, input from key experts, and feedback from experienced trainers and
practitioners, the Committee sought to define the professional practice that would be
appropriate for the addiction counselor of the 21st century. Eight Practice Dimensions
were identified, with the Committee recognizing that the counselor’s effectiveness
would depend on his or her ability to develop expertise in each. These dimensions
include the following:
Clinical Evaluation
Treatment Planning
Referral
Service Coordination
Counseling
Client, Family, and Community Education
Documentation
Professional and Ethical Responsibilities.
Several of these dimensions encompass specific Elements. Clinical evaluation,
for instance, includes both screening and assessment. Service coordination includes
three definable elements: implementing the treatment plan, consulting, and carrying on
the process of ongoing assessment and treatment planning. Counseling, of course,
includes the elements of individual, group, and family counseling.
The Committee’s delineation of the addiction counselor’s scope of practice
provided it with a context for identifying the competencies that are necessary for
effective functioning in the addiction counselor role. Each dimension carries its own set
of Competencies. Many additional competencies may be desirable for counselors in
specific settings. In addition, education and experience will affect the depth of the
individual counselor’s knowledge and skills. Our goal for the future, however, is that
every addiction counselor possess every competency listed on these pages, regardless
of setting or treatment model.
The competencies underlying effective practice of addiction counseling were
introduced in a 1995 publication (see Appendix C for a revised edition, entitled
Addiction Counseling Competencies). The Committee members recognized that
greater detail is needed to make this schema useful for program development,
evaluation, and training. Thus, the current full document lists the Knowledge, Skills,
and Attitudes that combine to ensure attainment of each of the competencies listed in
the document presented in Appendix C.
4
Introduction
National Curriculum Committee
Using This Document
This document is not intended to be a curriculum that must be followed in a
specific sequence. Instead, it identifies the knowledge, skills, and attitudes that could
serve as outcomes toward which curricula might aim. Settings, time constraints, and
levels of counselor training diverge widely. For this reason, we provide a set of
outcome guidelines that may be used to meet varying needs. Educators and
curriculum developers can build courses, curricula, and training packages oriented
toward these outcomes. Counseling practitioners can assess their own progress
toward achieving the competencies. Supervisory and administrative personnel can use
the materials to identify in-service training and continuing education needs within their
agencies.
As the Committee stated in our first publication, we know that the field of
addiction counseling will be characterized by significant change in the coming decades.
No one can predict in great detail the specifics of each counselor’s setting, clientele,
and practice. Nevertheless, we can predict with certainty that addiction counselors of
the future will be individuals who are comfortable with the process of lifelong learning,
who are able to apply their skills in a variety of settings, and who welcome the
opportunity to develop new strategies in response to the changing needs of their clients
and communities.
Inquiries may be directed to the Committee chair: David A. Deitch, Ph.D.,
California Addiction Technology Transfer Center, UCSD School of Medicine, 565 Pearl
St., Suite 360, La Jolla, California 92037.
Addiction Counseling Competencies
5
Addiction Technology Transfer Center Program
ACKNOWLEDGMENTS
The Committee responsible for this document includes representatives from the
network of Addiction Technology Transfer Centers (ATTCs) and the Center for
Substance Abuse Treatment (CSAT). The content represents a consensus that
emerged from an intense collaboration over the course of three years. The original
work resulted in the release of Addiction Counselor Competencies, published in
September 1995. In the process of review, the Committee elected to change the title
from Addiction Counselor Competencies to Addiction Counseling Competencies to
reflect the broader application of the document. In publishing Addiction Counseling
Competencies: The Knowledge, Skills, and Attitudes of Professional Practice (1997) we
recognize that the ideas contained here will continue to change over time. This work
represents our commitment to modify, add to, or expand the document as appropriate.
The Committee wishes to thank Jerome H. Jaffe, M.D., Director, Office of
Evaluation, Scientific Analysis, and Synthesis, CSAT, and Susanne R. Rohrer, ATTC
Project Officer for their ongoing support of the project.
This document represents countless hours of dedicated work by the core
committee of representatives from the national network of Addiction Technology
Transfer Centers and the Center for Substance Abuse Treatment.
COMMITTEE MEMBERS
David A. Deitch, Ph.D. (Chair)
California Addiction Technology Transfer Center
University of California San Diego
La Jolla, California
Steven L. Gallon, Ph.D.
Northwest Frontier Addiction Technology Transfer Center
Office of Alcohol and Drug Abuse Programs
Salem, Oregon
Paula K. Horvatich, Ph.D.
Virginia Addiction Technology Transfer Center
Virginia Commonwealth University
Richmond, Virginia
Mary Beth Johnson, M.S.W.
Missouri Addiction Technology Transfer Center
University of Missouri - Kansas City
Kansas City, Missouri
6
Acknowledgments
National Curriculum Committee
Karen Kelly-Woodall, M.S., M.A.C., C.R.P.S., C.C.S., C.C.J.S
Morehouse School of Medicine Addiction Technology Transfer Center
CORK Institute
Atlanta, Georgia
Judy Lewis, Ph.D.
Illinois Addiction Technology Transfer Center
Governors State University
University Park, Illinois
Alan M. Parsons, M.S.W., A.C.S.W.
New York State Addiction Technology Transfer Center
State University of New York at Albany
Albany, New York
Nereida Diaz Rodriguez, M.A.
Puerto Rico Addiction Technology Transfer Center
Universidad Central del Caribe
Bayamon, Puerto Rico
Susanne R. Rohrer, R.N., M.B.A.
Center for Substance Abuse Treatment
Substance Abuse and Mental Health Services Administration
Washington, D.C.
Kevin R. Scheel, M.S., M.A.C., L.M.F.T.
Addiction Technology Transfer Center Consultant
(formerly with the Texas Addiction Technology Transfer Center)
Apple Valley, Minnesota
Anne Helene Skinstad, Psy.D.
Addiction Technology Transfer Center of Iowa
University of Iowa
Iowa City, Iowa
Susan A. Storti, R.N., M.A., C.D.N.S., C.A.S.
Addiction Technology Transfer Center of New England
Brown University Center for Alcohol and Addiction Studies
Providence, Rhode Island
Addiction Counseling Competencies
7
Addiction Technology Transfer Center Program
The Committee wishes to thank the expert consultants, field reviewers, and the
National Steering Committee on Addiction Counseling Standards for their invaluable
contributions and dedication to advancing the profession of addictions counseling.
Consultants
Janice Bennett, International Certification Reciprocity Consortium (ICRC)
Sandra Brown, American Psychological Association (APA)
Linda Foley, National Association of State Alcohol & Drug Abuse Directors (NASADAD)
Linda Kaplan, National Association of Alcoholism & Drug Abuse Counselors (NAADAC)
Richard Wilson, International Coalition of Addiction Studies Educators (INCASE)
Field Reviewers
8
Holly M. Anderson, M.S.
Instructor, Chemeketa Community College
Sandra C. Anderson, Ph.D.
Professor, Graduate School of Social Work,
Portland State University
Steve Applegate, M.Ed., M.Ed.
Instructional Design Specialist,
North Carolina Governor’s Institute on
Alcohol and Substance Abuse
Remi J. Cadoret
Professor of Psychiatry, University of Iowa
Evadne Cox-McCleary
Instructor, Puerto Rico ATTC
Donald V. Cline, M.Ed., M.A.
Associate Superintendent, Missouri Department of
Corrections - Jefferson City Correctional Center
George De Leon, Ph.D.
Director, Center for Therapeutic Community Research
Thomas M. Delegatto
Coordinator, Basic Addiction Counseling Program,
Triton College
Maria Del Mar Garcia, MSW, MHS
Criminal Justice Track Coordinator, Puerto Rico ATTC
Dallas M. Dolan, M.S.,
CCDC, CPC
Associate Professor, Dundalk Community College
Arthur C. Evans, Ph.D.
Clinical Director, South Central Rehabilitation Center
Terence T. Gorski
President, CENAPS Corporation
Rick Gressard, Ph.D.,
LPC, MAC
Associate Professor, College of William and Mary
Richard Hayton, M.A.
Counselor Certification Director, Missouri Division of
Alcohol and Drug Abuse
Lorraine K. Hill
Executive Director, Cattaraugus County Council on
Alcoholism and Substance Abuse, Inc.
Steve Jaggers, M.S.
Instructor/Program Director, Mt. Hood Community College
Acknowledgments
National Curriculum Committee
Linda Kaplan, M.A., CA
Executive Director, National Association of Alcoholism
and Drug Abuse Counselors
Gary Lawson, Ph.D.
Professor, Department of Psychology and Family Studies,
U.S. International University
Peter Manoleas, LCSW
Lecturer/Field Consultant, University of California at
Berkeley
Merlene Miller, M.A.
Associate Professor, Graceland College
David Miller, M.A., CSAC II
Associate Professor, Graceland College
Peter E. Nathan
Professor of Psychology, University of Iowa
Eileen McCabe O’Mara
Associate Professor, University of Nevada, Reno
Peter Palanca
Executive Director, Hazelden Chicago
Anthony R. Quintiliani, Ph.D.,
NCAC II
Clinical Director/Chief Psychologist, CDAS/HCHS
Mark Sanders, LCSW, CADC
Speaker, Trainer, Consultant
Arthur J. Schut
Executive Director, Mid-Eastern Council on Chemical
Abuse
Howard J. Shaffer, Ph.D.
Director and Associate Professor,
Harvard Medical School - Division on Addictions
William L. Shilley, M.A.
Professor, Oxnard College
Digna Betancourt Swingle,
CSW
Interim Executive Director, Catholic Family and
Community Services of Montgomery County
Tom TenEyck, M.A.
Instructor, Mt. Hood Community College and Lewis &
Clark College
Kevin Wadalavage
Vice President, Outreach Project
Joan E. Zweben, Ph.D.
Executive Director, 14th Street Clinic & Medical Group,
East Bay Community Recovery Project
Janet Zwick
Director, Division of Substance Abuse and Health
Promotion, Iowa Department of Public Health
Addiction Counseling Competencies
9
Addiction Technology Transfer Center Program
National Steering Committee on Addiction Counseling Standards
Carolyn S. Barrett-Ballinger
President, International Certification
Reciprocity Consortium
Department of the Navy
Washington, D.C.
Janice S. Bennett, M.S., CSAC.
Project Director, Hawaii ATTC
Honolulu, Hawaii
Greg Blevins, Ph.D.
International Coalition of
Addiction Studies Educators
Governors State University
University Park, Illinois
David A. Deitch, Ph.D.
Project Director, California ATTC
University of California San Diego
La Jolla, California
Steven L. Gallon, Ph.D.
Project Director, Northwest Frontier ATTC
Salem, Oregon
Paul Grace, M.S.
Executive Director, International
Certification Reciprocity Consortium
Raleigh, North Carolina
Paula K. Horvatich, Ph.D.
Project Director, Virginia ATTC
Virginia Commonwealth University
Richmond, Virginia
Linda Kaplan, M.A. CAE
Executive Director
National Association of Alcoholism and
Drug Abuse Counselors
Arlington, Virginia
Roxanne Kibben, M.A., NCAC II
President, National Association of
Alcoholism and Drug Abuse Counselors
Tucson, Arizona
10
Bruce Lorenz, NCAC II
National Association of Alcoholism and
Drug Abuse Counselors
Chair, Certification Commission
Dover, Delaware
Janet Mann
Associate Director
American Academy of Health Care
Providers in the Addictive Disorders
Cambridge, Massachusetts
Neal McGarry
President-Elect, International Certification
Reciprocity Consortium
Certification Board for Addiction
Professionals of Florida
Tallahassee, Florida
Peter Myers, Ph.D.
President, International Coalition of
Addiction Studies Educators
Essex Community College
Newark, New Jersey
Jeff Pearcy, M.P.A., CADC III
Vice President, International Certification
Reciprocity Consortium
Wauwatosa, Wisconsin
Paul D. Potter, M.S.W., MAC
NAADAC/NCAC Commissioner
Portland, Oregon
Susanne R. Rohrer, R.N., M.B.A.
Center for Substance Abuse Treatment
Rockville, Maryland
Michael Taleff, Ph.D., CAC, MAC
International Coalition of
Addiction Studies Educators
Penn State University
University Park, Pennsylvania
Acknowledgments
National Curriculum Committee
SECTION 1:
TRANSDISCIPLINARY
FOUNDATIONS
INTRODUCTION TO THE TRANSDISCIPLINARY FOUNDATIONS
Addictions professionals work in a broad variety of disciplines but
share an understanding of the addictive process that goes beyond the
narrow confines of any one specialty. Specific proficiencies, skills, levels of
involvement with clients, and scope of practice do vary widely among
specializations. At their base, however, all addiction-focused disciplines are
built on a common foundation.
This section focuses on a set of competencies that are
transdisciplinary in that they underlie the work not just of counselors but of
all addictions professionals. The areas of knowledge identified here serve
as prerequisites to the development of competency in any of the practice
specialties. These foundations include:
Understanding Addiction
Treatment Knowledge
Application to Practice
Professional Readiness.
Regardless of professional identity or discipline, each treatment
provider must have a basic understanding of addiction that includes
knowledge of current models and theories, appreciation of the multiple
contexts within which substance use occurs, and awareness of the effects of
psychoactive drug use. Each professional must be knowledgeable about
the continuum of care and the social contexts affecting the treatment and
recovery process. Each addictions specialist must be able to identify a
variety of helping strategies that can be tailored to meet the needs of the
individual client. Each professional must be prepared to adapt to an everchanging set of challenges and constraints.
Addiction Counseling Competencies
11
Addiction Technology Transfer Center Program
Although specific skills and applications vary across disciplines, the
attitudinal components tend to remain constant. The development of
effective practice in addictions depends on the presence of attitudes
reflecting openness to alternative approaches, appreciation of diversity, and
willingness to change.
12
Introduction to the Transdisciplinary Foundations
National Curriculum Committee
I.
TRANSDISCIPLINARY FOUNDATIONS
The following knowledge and attitudes are prerequisite to the
development of competency in the professional treatment of substance use
disorders. Such knowledge and attitudes form the basis of understanding
upon which discipline-specific proficiencies are built.
A.
UNDERSTANDING ADDICTION
1. Understand a variety of models and theories of addiction and
other problems related to substance use.
Knowledge
a. Terms and concepts related to theory, research, and practice.
b. Scientific and theoretical basis of models from medicine,
psychology, sociology, religious studies, and other disciplines.
c. Criteria and methods for evaluating models and theories.
d. Appropriate applications of models.
e. How to access addiction-related literature from multiple
disciplines.
Attitudes
a. Openness to information that may differ from personally held
views.
b. Appreciation of the complexity inherent in understanding
addiction.
c. Valuing of diverse concepts, models, and theories.
d. Willingness to form personal concepts through critical thinking.
2. Recognize the social, political, economic, and cultural
context within which addiction and substance abuse exist,
including risk and resiliency factors that characterize
individuals and groups and their living environments.
Knowledge
a. Basic concepts of social, political, economic, and cultural
systems and their impact on drug-taking activity.
b. The history of licit and illicit drug use.
c. Research reports and other literature identifying risk and
resiliency factors for substance use.
Addiction Counseling Competencies
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Addiction Technology Transfer Center Program
d. Statistical information regarding the incidence and prevalence
of substance use disorders in the general population and major
demographic groups.
Attitudes
a. Recognition of the importance of contextual variables.
b. Appreciation for differences between and within cultures.
3. Describe the behavioral, psychological, physical health, and
social effects of psychoactive substances on the user and
significant others.
Knowledge
a. Fundamental concepts of pharmacological properties and
effects of all psychoactive substances.
b. Knowledge of the continuum of drug use, such as initiation,
intoxication, harmful use, abuse, dependence, withdrawal,
craving, relapse, and recovery.
c. Behavioral, psychological, social, and health effects of
psychoactive substances.
d. The effects of chronic substance use on consumers, significant
others, and communities within a social, political, cultural, and
economic context.
e. The varying courses of addiction.
f. The relationship between infectious diseases and substance
use.
Attitudes
a. Sensitivity to multiple influences in the developmental course of
addiction.
b. Interest in scientific research findings.
4. Recognize the potential for substance use disorders to mimic
a variety of medical and psychological disorders and the
potential for medical and psychological disorders to co-exist
with addiction and substance abuse.
Knowledge
a. Normal human growth and development.
b. Symptoms of substance use disorders that are similar to those
14
Foundations
Transdisciplinary
National Curriculum Committee
of other medical and/or psychological disorders and how these
disorders interact.
c. The medical and psychological disorders that most commonly
exist with addiction and substance use disorders.
d. Methods for differentiating substance use disorders from other
medical or psychological disorders.
Attitudes
a. Willingness to reserve judgment until completion of a thorough
clinical evaluation.
b. Willingness to work with people who might display and/or have
psychological disorders.
c. Willingness to refer for disorders outside one’s expertise.
d. Appreciation of the contribution of multiple disciplines to the
evaluation process.
B.
TREATMENT KNOWLEDGE
1. Describe the philosophies, practices, policies, and outcomes
of the most generally accepted and scientifically supported
models of treatment, recovery, relapse prevention, and
continuing care for addiction and other substance-related
problems.
Knowledge
a. Generally accepted models, such as but not limited to:
- pharmacotherapy,
- mutual help and self help,
- behavioral self-control training,
- mental health,
- self-regulating community,
- psychotherapeutic,
- relapse prevention,
- multimodality.
b. The philosophy, practices, policies, and outcomes of the most
generally accepted models.
c. Alternative models that demonstrate potential.
Attitudes
a. Acceptance for the validity of a variety of approaches and
Addiction Counseling Competencies
15
Addiction Technology Transfer Center Program
models.
2. Recognize the importance of family, social networks, and
community systems in the treatment and recovery process.
Knowledge
a. The role of family, social networks, and community systems as
assets or obstacles in the treatment and recovery process.
b. Methods for incorporating family and social dynamics in
treatment and recovery processes.
Attitudes
a. Appreciation for the significance and complementary nature of
various systems in facilitating treatment and recovery.
3. Understand the importance of research and outcome data
and their application in clinical practice.
Knowledge
a. Research methods in the social and behavioral sciences.
b. Sources of research literature relevant to the prevention and
treatment of addiction.
c. Specific research on epidemiology, etiology, and treatment
efficacy.
Attitudes
a. Recognition of the importance of scientific research to the
delivery of addiction treatment.
b. Openness to new information.
4. Understand the value of an interdisciplinary approach to
addiction treatment.
Knowledge
a. Roles and contributions of multiple disciplines to treatment
efficacy.
b. Terms and concepts necessary to communicate effectively
across disciplines.
c. The importance of communication with other disciplines.
16
Foundations
Transdisciplinary
National Curriculum Committee
Attitudes
a. Desire to collaborate.
b. Respect for the contribution of multiple disciplines to the
recovery process.
c. Commitment to professionalism.
C.
APPLICATION TO PRACTICE
1. Understand the established diagnostic criteria for substance
use disorders and describe treatment modalities and
placement criteria within the continuum of care.
Knowledge
a. Established diagnostic criteria, including but not limited to:
- current Diagnostic Statistical Manual (DSM) standards,
- current International Classification of Diseases (ICD)
standards.
b. Established placement criteria developed by various states and
professional organizations.
c. Strengths and limitations of various diagnostic and placement
criteria.
d. Continuum of treatment services and activities.
Attitudes
a. Openness to a variety of treatment services based on client
need.
b. Recognition of the value of research findings.
2. Describe a variety of helping strategies for reducing the
negative effects of substance use, abuse, and dependence.
Knowledge
a. A variety of helping strategies, including but not limited to:
- evaluation methods and tools,
- stage appropriate interventions,
- motivational interviewing,
- involvement of family and significant others,
- mutual-help and self-help programs,
- coerced and voluntary care models,
- brief and longer-term interventions.
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Attitudes
a. Openness to various approaches to recovery.
b. Appreciation that different approaches work for different people.
3. Tailor helping strategies and treatment modalities to the
client’s stage of dependence, change, or recovery.
Knowledge
a. Strategies appropriate to the various stages of dependence,
change, and recovery.
Attitudes
a. Flexibility in choice of treatment modalities.
b. Respect for the client’s racial, cultural, economic, and sociopolitical backgrounds.
4. Provide treatment services appropriate to the personal and
cultural identity and language of the client.
Knowledge
a. Various cultural norms, values, beliefs, and behaviors.
b. Cultural differences in verbal and non-verbal communication.
c. Resources to help develop individualized treatment plans.
Attitudes
a. Respect for individual differences within cultures.
b. Respect for differences between cultures.
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5. Adapt practice to the range of treatment settings and
modalities.
Knowledge
a. The strengths and limitations of available treatment settings
and modalities.
b. How to access and make referrals to available treatment
settings and modalities.
Attitudes
a. Flexibility and creativity in practice application.
6. Be familiar with medical and pharmacological resources in
the treatment of substance use disorders.
Knowledge
a. Current literature regarding medical and pharmacological
interventions.
b. Assets and liabilities of medical and pharmacological
interventions.
c. Health practitioners in the community who are knowledgeable
about addiction and addiction treatment.
d. The role that medical problems and complications can play in
the intervention and treatment of addiction.
Attitudes
a. Openness to the potential risks and benefits of
pharmacotherapies to the treatment and recovery process.
7. Understand the variety of insurance and health maintenance
options available and the importance of helping clients
access those benefits.
Knowledge
a. Existing public and private payment plans including treatment
orientation and coverage options.
b. Methods for gaining access to available payment plans.
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c. Policies and procedures used by available payment plans.
d. Key personnel, roles, and positions within plans used by the
client population.
Attitudes
a. Willingness to cooperate with payment providers.
b. Willingness to explore treatment alternatives.
c. Interest in promoting the most cost-effective, high quality care.
8. Recognize that crisis may indicate an underlying substance
use disorder and may be a window of opportunity for change.
Knowledge
a. The features of crisis, which may include but are not limited to:
- family disruption,
- social and legal consequences,
- physical and psychological panic states,
- physical dysfunction.
b. Substance use screening and assessment methods.
c. Intervention principles and methods.
d. Principles of crisis case management.
e. Post-traumatic stress characteristics.
f. Critical incident debriefing methods.
g. Available resources for assistance in the management of crisis
situations.
Attitudes
a. Willingness to respond and follow through in crisis situations.
b. Willingness to consult when necessary.
9. Understand the need for and the use of methods for
measuring treatment outcome.
Knowledge
a. Treatment outcome research literature.
b. Scientific process in applied research.
c. Methods for measuring the multiple variables of treatment
outcome.
Attitudes
a. Recognition of the importance of collecting and reporting on
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outcome data.
b. Interest in integrating research findings into ongoing treatment
design.
D.
PROFESSIONAL READINESS
1. Understand diverse cultures and incorporate the relevant
needs of culturally diverse groups, as well as people with
disabilities, into clinical practice.
Knowledge
a. Information and resources regarding racial and ethnic cultures,
lifestyles, gender, age, ethnic, racial, and relevant needs of
people with disabilities.
b. The unique influence the client’s culture, lifestyle, gender, and
other relevant factors may have on behavior.
c. The relationship between substance use and diverse cultures,
values, and lifestyles.
d. Assessment and intervention methods that are appropriate to
culture and gender.
e. Counseling methods relevant to the needs of culturally diverse
groups and people with disabilities.
f. The Americans with Disabilities Act and other legislation related
to human, civil, and client rights.
Attitudes
a. Willingness to explore and identify one’s own cultural values.
b. Acceptance of other cultural values as valid for other
individuals.
2. Understand the importance of self-awareness in one’s
personal, professional, and cultural life.
Knowledge
a. Personal and professional strengths and limitations.
b. Cultural, ethnic, or gender biases.
Attitudes
a. Openness to constructive supervision.
b. Willingness to grow and change personally and professionally.
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3. Understand the addiction professional’s obligations to adhere
to ethical and behavioral standards of conduct in the helping
relationship.
Knowledge
a. State and Federal regulations related to the practice of
addiction treatment.
b. Scope-of-practice standards.
c. Legal, ethical, and behavioral standards.
d. Discipline-specific ethics code.
Attitudes
a. Willingness to operate in accordance with the highest ethical
standards.
b. Willingness to comply with regulatory and professional
expectations.
c. Respect for therapeutic boundaries.
4. Understand the importance of ongoing supervision and
continuing education in the delivery of client services.
Knowledge
a. Benefits of self-assessment and clinical supervision to
professional growth and development.
b. The value of consultation to enhance personal and professional
growth.
c. Resources available for continuing education.
d. Supervision principles and methods.
Attitudes
a. Commitment to continuing professional education.
b. Willingness to engage in a supervisory relationship.
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5. Understand the obligation of the addiction professional to
participate in prevention as well as treatment.
Knowledge
a. Research-based prevention models and strategies.
b. The relationship between primary, secondary, and tertiary
prevention and treatment.
Attitudes
a. Appreciation of the inherent value of prevention.
b. Openness to research-based prevention strategies.
6. Understand and apply setting-specific policies and
procedures for handling crisis or dangerous situations,
including safety measures for clients and staff.
Knowledge
a. Setting-specific policies and procedures.
b. What constitutes a crisis or danger to the client and/or others.
c. The range of appropriate responses to a crisis or dangerous
situation.
d. Universal precautions.
e. Legal implications of crisis response.
f. Exceptions to confidentiality rules in crisis or dangerous
situations.
Attitudes
a. Understanding of the potential seriousness of crisis situations.
b. Awareness for the need for caution and self-control in the face
of crisis or danger.
c. Willingness to request help in potentially dangerous situations.
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SECTION 2:
THE PROFESSIONAL PRACTICE
OF ADDICTION COUNSELING
INTRODUCTION TO THE PROFESSIONAL
PRACTICE OF ADDICTION COUNSELING
Professional practice for addiction counselors is based on eight
Practice Dimensions, each of which is necessary for effective performance
of the counseling role. Several of these dimensions include subelements.
The dimensions we have identified, along with the competencies that
support them, form the heart of this section of the document.
The counselor’s success in carrying out a practice dimension depends
on his or her ability to attain the Competencies underlying that component.
Each competency, in turn, depends on its own set of knowledge, skills, and
attitudes. In order for an addiction counselor to be truly effective, he or she
should possess the knowledge, skills, and attitudes listed under each
dimension.
The eight practice dimensions of addiction counseling include the
following:
Clinical Evaluation
Screening
Assessment
Treatment Planning
Referral
Service Coordination
Implementing the Treatment Plan
Consulting
Continuing Assessment and Treatment
Planning
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Counseling
Individual Counseling
Group Counseling
Counseling for Families, Couples, and
Significant Others
Client, Family, and Community Education
Documentation
Professional and Ethical Responsibilities
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I.
CLINICAL EVALUATION
The systematic approach to screening and assessment.
A.
SCREENING
The process through which counselor, client and available significant
others determine the most appropriate initial course of action, given
the client's needs and characteristics, and the available resources
within the community.
1. Establish rapport, including management of crisis situation
and determination of need for additional professional
assistance.
Knowledge
a.
b.
c.
d.
e.
f.
Importance and purpose of rapport building.
Rapport-building methods and issues.
The range of human emotions and feelings.
What constitutes a crisis.
Steps in crisis management.
Situations in which additional professional assistance may be
necessary.
g. Available sources of assistance.
Skills
a.
b.
c.
d.
e.
Demonstrating effective verbal and nonverbal communication.
Accurately identifying client's frame of reference.
Reflecting client’s feelings and message.
Recognizing and defusing volatile or dangerous situations.
Demonstrating empathy, respect, and genuineness.
Attitudes
a. Recognition of personal biases, values, and beliefs, and their
effect on communication and the treatment process.
b. Willingness to establish rapport.
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2. Gather data systematically from the client and other available
collateral sources, using screening instruments and other
methods that are sensitive to age, developmental level,
culture, and gender. At a minimum, data should include
current and historic substance use; health, mental health,
and substance related treatment history; mental status; and
current social, environmental, and/or economic constraints.
Knowledge
a. Validated screening instruments, including their purpose,
application, and limitations.
b. Concepts of reliability and validity as they apply to screening
instruments.
c. How to interpret the results of screening.
d. How to gather and use information from collateral sources.
e. How age, developmental level, culture, and gender effect
patterns and history of use.
f. How age, developmental level, culture, and gender effect
communication.
g. Client mental status:
- presenting features,
- relationship to substance abuse and psychiatric disorders.
h. How to apply confidentiality regulations.
Skills
a.
b.
c.
d.
e.
Administering and scoring screening instruments.
Screening for physical and mental health status.
Gathering information and collecting data.
Communicating appropriately.
Writing accurately, concisely, and legibly.
Attitudes
a. Appreciation of the value of the data gathering process.
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3. Screen for psychoactive substance toxicity, intoxication, and
withdrawal symptoms; aggression or danger to others;
potential for self-inflicted harm or suicide; and coexisting
mental health problems.
Knowledge
a. Symptoms of intoxication, withdrawal, and toxicity for all
psychoactive substances, alone and in interaction with one
another.
b. Physical, pharmacological, and psychological implications of
psychoactive substance use.
c. Effects of chronic psychoactive substance use or intoxication on
cognitive abilities.
d. Available resources for help with drug reactions, withdrawal,
and violent behavior.
e. When to refer for toxicity screening or additional professional
help.
f. Basic concepts of toxicity screening options, limitations, and
legal implications.
g. Toxicology reporting language and the meaning of toxicology
reports.
h. Relationship between psychoactive substance use and
violence.
i. Basic diagnostic criteria for suicide risk, danger to others,
withdrawal syndromes, and major psychiatric disorders.
j. Mental and physical conditions that mimic drug intoxication,
toxicity, and withdrawal.
k. Legal requirements concerning suicide and violence potential.
Skills
a.
b.
c.
d.
Eliciting relevant information from the client.
Intervening appropriately with a client who may be intoxicated.
Assessing suicide and/or violence potential.
Managing crises.
Attitudes
a. Willingness to be respectful toward the client in his or her
presenting state.
b. Appreciation of the importance of empathy in the face of
feelings of anger, hopelessness, suicidal or violent thoughts,
and feelings.
c. Appreciation of the importance of legal obligations.
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4. Assist the client in identifying the impact of substance use on
his or her current life problems and the effects of continued
harmful use or abuse.
Knowledge
a. The progression and characteristics of substance use
disorders.
b. The effects of psychoactive substances on behavior, thinking,
feelings, health status, and relationships.
c. Denial and other defense mechanisms in client resistance.
Skills
a. Establishing a therapeutic relationship.
b. Demonstrating effective communication skills.
c. Determining and confirming the effects of substance use on life
problems with the client.
d. Assessing client readiness to address substance use issues.
e. Interpreting the client’s perception of his or her experiences.
Attitudes
a. Respect for the client’s perception of his or her experiences.
5. Determine the client's readiness for treatment and change as
well as the needs of others involved in the current situation.
Knowledge
a. Current validated instruments for assessing readiness to
change.
b. Treatment options.
c. Stages of readiness.
d. Stages of change models.
e. The role of family and significant others in supporting or
hindering change.
Skills
a. Assessing client readiness for treatment.
b. Assessing extrinsic and intrinsic motivators.
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Attitudes
a. Acceptance of non-readiness as a stage of change.
b. Appreciation that motivation is not a pre-requisite for treatment.
c. Recognition of the importance of the client’s self assessment.
6. Review the treatment options that are appropriate for the
client's needs, characteristics, goals, and financial resources.
Knowledge
a. Treatment options and their philosophies and characteristics.
b. Appropriate treatment options for client needs.
Skills
a. Eliciting and determining relevant client characteristics, needs,
and goals.
b. Making appropriate recommendations for treatment.
Attitudes
a. Recognition of one’s own treatment biases.
b. Appreciation of various treatment approaches.
7. Apply accepted criteria for diagnosis of substance use
disorders in making treatment recommendations.
Knowledge
a. The continuum of care and the available range of treatment
modalities.
b. Current DSM or other accepted criteria for substance use
disorders, including strengths, and limitations of such criteria.
c. Use of commonly accepted criteria for client placement into
levels of care.
d. Multi-axis diagnostic criteria.
Skills
a. Using current DSM or other accepted diagnostic standards.
b. Using appropriate placement criteria.
c. Obtaining information necessary to develop a diagnostic
impression.
Attitudes
a. Recognition of personal and professional limitations of practice,
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based on knowledge and training.
b. Willingness to base treatment recommendations on the client’s
best interest.
8. Construct with client and appropriate others an initial action
plan based on client needs, preferences, and resources
available.
Knowledge
a. Appropriate content and format of the initial action plan.
b. Client needs and preferences.
c. Available resources for admission or referral.
Skills
a. Developing the action plan in collaboration with the client and
appropriate others.
b. Documenting the action plan.
c. Contracting with the client concerning initial action plan.
Attitudes
a. Willingness to work collaboratively with clients and others.
9. Based on initial action plan, take specific steps to initiate an
admission or referral and ensure follow-through.
Knowledge
a.
b.
c.
d.
e.
Admission and referral protocols.
Resources for referral.
Ethical standards regarding referrals.
Appropriate documentation.
How to apply confidentiality regulations.
Skills
a. Communicating clearly and appropriately.
b. Networking and advocating with service providers.
c. Negotiating and advocating client admissions to appropriate
treatment resources.
d. Facilitating client follow-through.
e. Documenting accurately and appropriately.
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Attitudes
a. Willingness to renegotiate.
B.
ASSESSMENT
An ongoing process through which the counselor collaborates with the
client and others to gather and interpret information necessary for
planning treatment and evaluating client progress.
1. Select and use a comprehensive assessment process that is
sensitive to age, gender, racial and ethnic cultural issues,
and disabilities that includes, but is not limited to:
- history of alcohol and other drug use;
- physical health, mental health, and addiction treatment
history;
- family issues;
- work history and career issues;
- history of criminality;
- psychological, emotional, and world-view concerns;
- current status of physical health, mental health, and
substance use;
- spirituality;
- education and basic life skills;
- socio-economic characteristics, lifestyle, and current
legal status;
- use of community resources.
Knowledge
a.
b.
c.
d.
Basic concepts of test validity and reliability.
Current validated assessment instruments and their subscales.
Appropriate use and limitations of standardized instruments.
The range of life areas to be assessed.
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e. How age, developmental level, racial and ethnic culture,
gender, and disabilities can influence the validity and
appropriateness of assessment instruments.
Skills
a. Selecting and administering appropriate assessment
instruments within the counselor’s scope of practice.
b. Introducing and explaining the purpose of assessment.
c. Addressing client perceptions and providing appropriate
explanations of instrument items.
d. Conducting comprehensive assessment interviews and
collecting information from collateral sources.
Attitudes
a. Respect for the limits of assessment instruments and one’s
ability to interpret them.
2. Analyze and interpret the data to determine treatment
recommendations.
Knowledge
a. Appropriate scoring methodology.
b. How to analyze and interpret results.
c. The range of available treatment options.
Skills
a.
b.
c.
d.
Scoring assessment tools.
Interpreting data relevant to the client.
Using results to identify appropriate treatment options.
Communicating recommendations to the client and other
appropriate service providers.
Attitudes
a. Respect for the value of assessment in determining appropriate
treatment.
3. Seek appropriate supervision and consultation.
Knowledge
a. The counselor’s role, responsibilities, and scope of practice.
b. The limits of the counselor’s training and education.
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c.
d.
e.
Skills
a.
b.
c.
d.
e.
The supervisor's role.
Available consultation services and roles of consultants.
The multidisciplinary assessment approach.
Recognizing the need for assistance from a supervisor.
Recognizing when consultation is appropriate.
Providing appropriate documentation.
Communicating information clearly.
Incorporating information from supervision and consultation into
assessment findings.
Attitudes
a. Commitment to professionalism.
b. Acceptance of one’s own personal and professional limitations.
4. Document assessment findings and treatment
recommendations.
Knowledge
a.
b.
c.
d.
Agency-specific protocols and procedures.
Appropriate terminology and abbreviations.
Legal implications of actions and documentation.
How to apply confidentiality regulations.
Skills
a. Providing clear, concise, and legible documentation.
b. Incorporating information from various sources.
c. Preparing and presenting oral and written assessment findings
to the client and other professionals within the bounds of how to
apply confidentiality regulations.
Attitudes
a. Recognition of the value of accurate documentation
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II. TREATMENT PLANNING
A collaborative process through which the counselor and client
develop desired treatment outcomes and identify the strategies for
achieving them.
At a minimum the treatment plan addresses the identified substance
use disorder(s), as well as issues related to treatment progress,
including relationships with family and significant others, employment,
education, spirituality, health concerns, and legal needs.
1. Obtain and interpret all relevant assessment information.
Knowledge
a.
b.
c.
d.
Stages of change and readiness for treatment.
The treatment planning process.
Motivation and motivating factors.
The role and importance of client resources and barriers to
treatment.
e. The impact that the client and family systems have on treatment
decisions and outcomes.
f. Other sources of assessment information.
Skills
a. Establishing treatment priorities based on all available data.
b. Working with clients of different age, developmental levels,
gender, racial, and ethnic cultures.
c. Interpreting data.
Attitudes
a. Appreciation of the strengths and limitations of the client and
significant others.
b. Recognition of the value of thoroughness and follow-through.
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2. Explain assessment findings to the client and significant
others involved in potential treatment.
Knowledge
a. How to apply confidentiality regulations.
b. Effective communication styles.
c. Factors effecting the client’s comprehension of assessment
findings.
d. Roles and expectations of others potentially involved in
treatment.
Skills
a. Translating assessment information into treatment goal and
outcomes.
b. Summarizing and synthesizing assessment results.
c. Assessing client for understanding and correcting
misunderstandings.
d. Communicating with clients in a manner that is sensitive to
cultural and gender issues.
e. Communicating assessment findings to interested parties within
the bounds of confidentiality regulations and practice
standards.
Attitudes
a. Recognition of one’s own treatment biases.
b. Willingness to consider multiple approaches to recovery and
change.
c. Recognition of the client’s right and need to understand
assessment results.
d. Respect for the roles of others.
3. Provide the client and significant others with clarification and
further information as needed.
Knowledge
a. Effective communication styles.
b. Methods to elicit feedback.
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Skills
a. Eliciting feedback.
b. Working collaboratively.
c. Establishing trusting relationship.
Attitudes
a. Willingness to communicate interactively with the client and
significant others.
4. Examine treatment implications in collaboration with the client
and significant others.
Knowledge
a. Available treatment modalities, client placement criteria, and
cost issues.
b. The effectiveness of the various treatment models based on
current research.
c. Implications of various treatment alternatives, including no
treatment.
Skills
a.
b.
c.
d.
Synthesizing available data to establish treatment priorities.
Explaining the treatment process.
Presenting information in a non-judgmental manner.
Selecting treatment settings appropriate for client needs and
preferences.
e. Building partnerships with client and significant others.
Attitudes
a. Willingness to negotiate with the client.
b. Open-mindedness toward a variety of approaches.
c. Respect for input from client and significant others.
5. Confirm the readiness of the client and significant others to
participate in treatment.
Knowledge
a. Motivational processes.
b. Stages of change models.
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Skills
a. Assessing and developing strategies to overcome barriers.
b. Eliciting the client’s preferences for treatment.
c. Promoting the client's readiness to accept treatment.
Attitudes
a. Respect for client values and goals.
b. Patience and perseverance.
6. Prioritize client needs in the order they will be addressed.
Knowledge
a. Treatment sequencing and the continuum of care.
b. Hierarchy of needs.
c. Interrelationship among client needs and problems.
Skills
a. Timing.
b. Sequencing.
c. Prioritizing.
Attitudes
a. Sensitivity to the client’s needs and perceptions.
7. Formulate mutually agreed upon and measurable treatment
outcome statements for each need.
Knowledge
a.
b.
c.
Skills
a.
Levels of client motivation.
Treatment needs of diverse populations.
How to write measurable outcome statements.
Translating assessment information into measurable treatment
goals and outcome statements.
b. Working with the client to develop realistic time frames for
completing goals.
c. Engaging, contracting, and negotiating with the client.
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Attitudes
a. Respect for the client’s treatment and life goals.
b. Respect for the client’s individual pace toward change.
c. Appreciation for incremental treatment goals and achievements.
8. Identify appropriate strategies for each outcome.
Knowledge
a. Intervention strategies.
b. Level of client’s interest in making specific changes.
c. Treatment issues with diverse populations.
Skills
a. Identifying alternate approaches tailored to client needs.
b. Implementing strategies in terms understandable to the client.
Attitudes
a. Respect for client and others.
b. Appreciation for various treatment strategies.
9. Coordinate treatment activities and community resources with
prioritized client needs in a manner consistent with the
client's diagnosis and existing placement criteria.
Knowledge
a. Treatment modalities and community resources.
b. Contributions of other professions and mutual-help or self-help
support groups.
c. Current placement criteria.
d. The importance of client’s racial or ethnic culture, age,
developmental level, gender, and life circumstances in
coordinating resources to client needs.
Skills
a. Coordinating resources and solutions with client needs,
desires, and preferences.
b. Explaining the rationale behind treatment recommendations.
c. Summarizing mutually agreed upon recommendations.
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Attitudes
a. Acceptance of a variety of treatment approaches.
b. Recognition of the importance of coordinating treatment
activities.
10. Develop with the client a mutually acceptable plan of action
and method for monitoring and evaluating progress.
Knowledge
a. The relationship among problem statements, desired outcomes,
and treatment strategies.
b. Short- and long-term treatment planning.
c. Evaluation methodology.
Skills
a. Individualizing treatment plans that balance strengths and
resources with problems and deficits.
b. Negotiating.
c. Collaborating and contracting with the client in developing an
action plan in positive, proactive terms.
d. Establishing criteria to evaluate progress.
Attitudes
a. Sensitivity to gender and cultural issues.
b. Recognition of the value of monitoring outcome.
c. Willingness to negotiate.
11. Inform client of confidentiality rights, program procedures
that safeguard them, and the exceptions imposed by
regulations.
Knowledge
a. Federal, State, and agency confidentiality regulations,
requirements, and policies.
b. Resources for legal consultation.
c. Effective communication styles.
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Skills
a. Communicating the roles of various interested parties and
support systems.
b. Explaining client rights and responsibilities and applicable
regulations regarding confidentiality.
c. Responding to questions and providing clarification as needed.
d. Referring to appropriate legal authority.
Attitudes
a. Respect for client confidentiality rights.
b. Commitment to professionalism.
c. Recognition of the importance of professional collaboration
within the bounds of confidentiality.
12. Reassess the treatment plan at regular intervals and/or
when indicated by changing circumstances.
Knowledge
a. How to evaluate treatment and stages of recovery.
b. When and how to review and revise the treatment plan.
Skills
a. Modifying the treatment plan based on review of client progress
and/or changing circumstances.
b. Problem solving.
c. Engaging, negotiating, and contracting.
d. Eliciting client feedback on treatment experiences.
Attitudes
a. Recognition of the value of client input into treatment goals and
process.
b. Openness when critically examining one’s own work.
c. Receptivity to client feedback.
d. Willingness to learn from clinical supervision and modify
practice appropriately.
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III. REFERRAL
The process of facilitating the client’s utilization of available support
systems and community resources to meet needs identified in clinical
evaluation and/or treatment planning.
1. Establish and maintain relations with civic groups, agencies,
other professionals, governmental entities, and the
community-at-large to ensure appropriate referrals, identify
service gaps, expand community resources, and help to
address unmet needs.
Knowledge
a. The mission, function, resources, and quality of services offered
by such entities as the following:
- civic groups, community groups, and neighborhood
organizations;
- religious organizations;
- governmental entities;
- health and allied health care systems (managed care);
- criminal justice systems;
- housing administrations;
- employment and vocational rehabilitation services;
- child care facilities;
- crisis intervention programs;
- abused persons programs;
- mutual and self-help groups;
- cultural enhancement organizations;
- advocacy groups;
- other agencies.
b. Community demographics.
c. The community’s political and cultural systems.
d. Criteria for receiving community services, including fee and
funding structures.
e. How to access community agencies and service providers.
f. State and Federal legislative mandates and regulations.
g. Confidentiality regulations.
h. Service gaps and appropriate ways of advocating for new
resources.
i. Effective communication styles.
Addiction Counseling Competencies
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Addiction Technology Transfer Center Program
Skills
a. Networking and communication.
b. Using existing community resource directories including
computer databases.
c. Advocating for clients.
d. Working with others as part of a team.
Attitudes
a.
b.
c.
d.
Respect for interdisciplinary service delivery.
Respect for both client needs and agency services.
Respect for collaboration and cooperation.
Patience and perseverance.
2. Continuously assess and evaluate referral resources to
determine their appropriateness.
Knowledge
a. The needs of the client population served.
b. How to access current information on the function, mission, and
resources of community service providers.
c. How to access current information on referral criteria and
accreditation status of community service providers.
d. How to access client satisfaction data regarding community
service providers.
Skills
a. Establishing and nurturing collaborative relationships with key
contacts in community service organizations.
b. Interpreting and using evaluation and client feedback data.
c. Giving feedback to community resources regarding their service
delivery.
Attitudes
a. Respect for confidentiality regulations.
b. Willingness to advocate on behalf of the client.
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III. Referral
National Curriculum Committee
3. Differentiate between situations in which it is most
appropriate for the client to self-refer to a resource and
instances requiring counselor referral.
Knowledge
a. Client motivation and ability to initiate and follow through with
referrals.
b. Factors in determining the optimal time to engage client in
referral process.
c. Clinical assessment methods.
d. Empowerment techniques.
e. Crisis intervention methods.
Skills
a. Interpreting assessment and treatment planning materials to
determine appropriateness of client or counselor referral.
b. Assessing the client's readiness to participate in the referral
process.
c. Educating the client regarding appropriate referral processes.
d. Motivating clients to take responsibility for referral and followup.
e. Applying crisis intervention techniques.
Attitudes
a. Respect for the client’s ability to initiate and follow-up with
referral.
b. Willingness to share decision-making power with the client.
c. Respect for the goal of positive self-determination.
d. Recognition of the counselor’s responsibility to carry out client
advocacy when needed.
4. Arrange referrals to other professionals, agencies,
community programs, or other appropriate resources to meet
client needs.
Knowledge
a.
b.
c.
d.
Comprehensive treatment planning.
Methods of assessing client’s progress toward treatment goals.
How to tailor resources to client treatment needs.
How to access key resource persons in community service
provider network.
Addiction Counseling Competencies
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Addiction Technology Transfer Center Program
e. Mission, function, and resources of appropriate community
service providers.
f. Referral protocols of selected service providers.
g. Logistics necessary for client access and follow through with
the referral.
h. Applicable confidentiality regulations and protocols.
i. Factors to consider when determining the appropriate time to
engage client in referral process.
Skills
a. Using written and verbal communication for successful
referrals.
b. Using appropriate technology to access, collect, and forward
necessary documentation.
c. Conforming to all applicable confidentiality regulations and
protocols.
d. Documenting the referral process accurately.
e. Maintaining and nurturing relationships with key contacts in
community.
f. Maintaining follow-up activity with client.
Attitudes
a. Respect for the client and the client’s needs.
b. Respect for collaboration and cooperation.
c. Respect for interdisciplinary, comprehensive approaches to
meet client needs.
5. Explain in clear and specific language the necessity for and
process of referral to increase the likelihood of client
understanding and follow through.
Knowledge
a. How treatment planning and referral relate to the goals of
recovery.
b. How client defenses, abilities, personal preferences, cultural
influences, presentation, and appearance affect referral and
follow through.
c. Comprehensive referral information and protocols.
d. Terminology and structure used in referral settings.
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III. Referral
National Curriculum Committee
Skills
a. Using language and terms the client will easily understand.
b. Interpreting the treatment plan and how referral relates to
progress.
c. Engaging in effective communication related to the referral
process:
- negotiating,
- educating,
- personalizing risks and benefits,
- contracting.
Attitudes
a. Awareness of personal biases toward referral resources.
6. Exchange relevant information with the agency or
professional to whom the referral is being made in a manner
consistent with confidentiality regulations and generally
accepted professional standards of care.
Knowledge
a. Mission, function, and resources of the referral agency or
professional.
b. Protocols and documentation necessary to make referral.
c. Pertinent local, State, and Federal confidentiality regulations,
applicable client rights and responsibilities, client consent
procedures, and other guiding principles for exchange of
relevant information.
d. Ethical standards of practice related to this exchange of
information.
Skills
a. Using written and verbal communication for successful
referrals.
b. Using appropriate technology to access, collect, and forward
relevant information needed by the agency or professional.
c. Obtaining informed client consent and documentation needed
for the exchange of relevant information.
d. Reporting relevant information accurately and objectively.
Addiction Counseling Competencies
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Addiction Technology Transfer Center Program
Attitudes
a. Commitment to professionalism.
b. Respect for the importance of confidentiality regulations and
professional standards.
c. Appreciation for the need to exchange relevant information with
other professionals.
7. Evaluate the outcome of the referral.
Knowledge
a. Methods of assessing client’s progress toward treatment goals.
b. Appropriate sources and techniques for evaluating referral
outcomes.
Skills
a. Using appropriate measurement processes and instruments.
b. Collecting objective and subjective data on the referral process.
Attitudes
a. Appreciation of the value of the evaluation process.
b. Appreciation of the value of inter-agency collaboration.
c. Appreciation of the value of interdisciplinary referral.
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III. Referral
National Curriculum Committee
IV. SERVICE COORDINATION
The administrative, clinical, and evaluative activities that bring the
client, treatment services, community agencies, and other resources
together to focus on issues and needs identified in the treatment plan.
Service coordination, which includes case management and client
advocacy, establishes a framework of action for the client to achieve
specified goals. It involves collaboration with the client and significant
others, coordination of treatment and referral services, liaison
activities with community resources and managed care systems, client
advocacy, and ongoing evaluation of treatment progress and client
needs.
A. IMPLEMENTING THE TREATMENT PLAN
1. Initiate collaboration with referral source.
Knowledge
a. How to access and transmit information necessary for referral.
b. Missions, functions, and resources of community service
network.
c. Managed care and other systems affecting the client.
d. Eligibility criteria for referral to community service providers.
e. Appropriate confidentiality regulations.
f. Terminologies appropriate to the referral source.
Skills
a. Using appropriate technology to access, collect, summarize,
and transmit referral data on client.
b. Communicating respect and empathy for cultural and lifestyle
differences.
c. Demonstrating appropriate written and verbal communication.
d. Establishing trust and rapport with colleagues in the community.
e. Assessing level and intensity of client care needed.
Attitudes
a. Respect for contributions and needs of multiple disciplines to
treatment process.
Addiction Counseling Competencies
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Addiction Technology Transfer Center Program
b. Confidence in using diverse systems and treatment
approaches.
c. Open-mindedness to a variety of treatment approaches.
d. Willingness to modify or adapt plans.
2. Obtain, review, and interpret all relevant screening,
assessment, and initial treatment-planning information.
Knowledge
a. Methods for obtaining relevant screening, assessment, and
initial treatment-planning information.
b. How to interpret information for the purpose of service
coordination.
c. Theory, concepts, and philosophies of screening and
assessment tools.
d. How to define long- and short-term goals of treatment.
e. Biopsychosocial assessment methods.
Skills
a. Using accurate, clear, and concise written and verbal
communication.
b. Interpreting, prioritizing, and using client information.
c. Soliciting comprehensive and accurate information from
numerous sources including the client.
d. Using appropriate technology to document appropriate
information.
Attitudes
a. Appreciation for all sources and types of data and their possible
treatment implications.
b. Awareness of personal biases that may impact work with client.
c. Respect for client self-assessment and reporting.
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IV. Service Coordination
National Curriculum Committee
3. Confirm the client’s eligibility for admission and continued
readiness for treatment and change.
Knowledge
a. Philosophies, policies, procedures, and admission protocols for
community agencies.
b. Eligibility criteria for referral to community service providers.
c. Principles for tailoring treatment to client needs.
d. Methods of assessing and documenting client change over
time.
e. Federal and State confidentiality regulations.
Skills
a.
b.
c.
d.
e.
Working with client to select the most appropriate treatment.
Accessing available funding resources.
Using effective communication styles.
Recognizing, documenting, and communicating client change.
Involving family and significant others in treatment planning.
Attitudes
a. Recognition of the importance of continued support,
encouragement, and optimism.
b. Willingness to accept the limitations of treatment for some
clients.
c. Appreciation for the goal of self-determination.
d. Recognition of the importance of family and significant others to
treatment planning.
e. Appreciation of the need for continuing assessment and
modifications to the treatment plan.
4. Complete necessary administrative procedures for admission
to treatment.
Knowledge
a. Admission criteria and protocols.
b. Documentation requirements and confidentiality regulations.
c. Appropriate Federal, State, and local regulations related to
admission.
d. Funding mechanisms, reimbursement protocols, and required
documentation.
e. Protocols required by managed care organizations.
Addiction Counseling Competencies
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Addiction Technology Transfer Center Program
Skills
a. Demonstrating accurate, clear, and concise written and verbal
communication.
b. Using language the client will easily understand.
c. Negotiating with diverse treatment systems.
d. Advocating for client services.
Attitudes
a. Acceptance of the necessity to deal with bureaucratic systems.
b. Recognition of the importance of cooperation.
c. Patience and perseverance.
5. Establish accurate treatment and recovery expectations with
the client and involved significant others including, but not
limited to:
- nature of services,
- program goals,
- program procedures,
- rules regarding client conduct,
- schedule of treatment activities,
- costs of treatment,
- factors affecting duration of care,
- client rights and responsibilities.
Knowledge
a. Functions and resources provided by treatment services and
managed care systems.
b. Available community services.
c. Effective communication styles.
d. Client rights and responsibilities.
e. Treatment schedule, time frames, discharge criteria, and costs.
f. Rules and regulations of the treatment program.
g. Role and limitations of significant others in treatment.
h. How to apply confidentiality regulations.
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IV. Service Coordination
National Curriculum Committee
Skills
a. Demonstrating clear and concise written and verbal
communication.
b. Establishing appropriate boundaries with client and significant
others.
Attitudes
a. Respect for the contribution of clients and significant others.
6. Coordinate all treatment activities with services provided to
the client by other resources.
Knowledge
a. Methods for determining the client’s treatment status.
b. Documenting and reporting methods used by community
agencies.
c. Service reimbursement issues and their impact on the treatment
plan.
d. Case presentation techniques and protocols.
e. Applicable confidentiality regulations.
f. Terminology and methods used by community agencies.
Skills
a. Delivering case presentations.
b. Using appropriate technology to collect and interpret client
treatment information from diverse sources.
c. Demonstrating accurate, clear, and concise verbal and written
communication.
d. Participating in interdisciplinary team building.
e. Participating in negotiation, advocacy, conflict-resolution,
problem solving, and mediation.
Attitudes
a. Willingness to collaborate.
Addiction Counseling Competencies
53
Addiction Technology Transfer Center Program
B. CONSULTING
1. Summarize client’s personal and cultural background,
treatment plan, recovery progress, and problems inhibiting
progress for purpose of assuring quality of care, gaining
feedback, and planning changes in the course of treatment.
Knowledge
a. Methods for assessing client’s past and present
biopsychosocial status.
b. Methods for assessing social systems that may affect the
client’s progress.
c. Methods for continuous assessment and modification of the
treatment plan.
Skills
a. Demonstrating clear and concise written and verbal
communication.
b. Synthesizing information and developing modified treatment
goals and objectives.
c. Soliciting and interpreting feedback related to the treatment
plan.
d. Prioritizing and documenting relevant client data.
e. Observing and identifying problems that might impede
progress.
f. Soliciting client satisfaction feedback.
Attitudes
a. Respect for the personal nature of the information shared by
the client and significant others.
b. Respect for interdisciplinary work.
c. Appreciation for incremental changes.
d. Recognition of relapse as an opportunity for positive change.
2. Understand terminology, procedures, and roles of other
disciplines related to the treatment of substance use
disorders.
Knowledge
a. Functions and unique terminology of related disciplines.
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IV. Service Coordination
National Curriculum Committee
Skills
a. Demonstrating accurate, clear, and concise verbal and written
communication.
b. Participating in interdisciplinary collaboration.
c. Interpreting written and verbal data from various sources.
Attitudes
a. Comfort in asking questions and providing information across
disciplines.
3. Contribute as part of a multidisciplinary treatment team.
Knowledge
a. Roles, responsibilities, and areas of expertise of other team
members and disciplines.
b. Confidentiality regulations.
c. Team dynamics and group process.
Skills
a. Demonstrating clear and concise verbal and written
communication.
b. Participating in problem solving, decision making, mediation,
and advocacy.
c. Communicating about confidentiality issues.
d. Coordinating the client’s treatment with representatives of
multiple disciplines.
e. Participating in team building and group process.
Attitudes
a. Interest in cooperation and collaboration with diverse service
providers.
b. Respect and appreciation for other team members and their
disciplines.
4. Apply confidentiality regulations appropriately.
Knowledge
a. Federal, State, and local confidentiality regulations.
b. How to apply confidentiality regulations to documentation and
Addiction Counseling Competencies
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Addiction Technology Transfer Center Program
sharing of client information.
c. Ethical standards related to confidentiality.
d. Client rights and responsibilities.
Skills
a. Explaining and applying confidentiality regulations.
b. Obtaining informed consent.
c. Communicating with the client, family and significant others,
and with other service providers within the boundaries of
existing confidentiality regulations.
Attitudes
a. Recognition of the importance of confidentiality regulations.
b. Respect for a client’s right to privacy.
5. Demonstrate respect and non-judgmental attitudes toward
clients in all contacts with community professionals and
agencies.
Knowledge
a. Behaviors appropriate to professional collaboration.
b. Client rights and responsibilities.
Skills
a. Establishing and maintaining non-judgmental, respectful
relationships with clients and other service providers.
b. Demonstrating clear, concise, accurate communication with
other professionals or agencies.
c. Applying the confidentiality regulations when communicating
with agencies.
d. Transferring client information to other service providers in a
professional manner.
Attitudes
a. Willingness to advocate on behalf of the client.
b. Professional concern for the client.
c. Commitment to professionalism.
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IV. Service Coordination
National Curriculum Committee
C. CONTINUING ASSESSMENT AND
TREATMENT PLANNING
1. Maintain ongoing contact with client and involved significant
others to ensure adherence to the treatment plan.
Knowledge
a.
b.
c.
d.
Social, cultural, and family systems.
Techniques to engage the client in treatment process.
Outreach, follow-up, and aftercare techniques.
Methods for determining the client’s goals, treatment plan, and
motivational level.
e. Assessment mechanisms to measure client’s progress toward
treatment objectives.
Skills
a. Engaging client, family, and significant others in the ongoing
treatment process.
b. Assessing client progress toward treatment goals.
c. Helping the client maintain motivation to change.
d. Assessing the comprehension level of the client, family, and
significant others.
e. Documenting the client’s adherence to the treatment plan.
f. Recognizing and addressing ambivalence and resistance.
g. Implementing follow-up and aftercare protocols.
Attitudes
a. Professional concern for the client, the family, and significant
others.
b. Therapeutic optimism.
c. Recognition of relapse as an opportunity for positive change.
d. Patience and perseverance.
2. Understand and recognize stages of change and other signs
of treatment progress.
Knowledge
a. How to recognize incremental progress toward treatment goals.
b. Client’s cultural norms, biases, unique characteristics, and
preferences for treatment.
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Addiction Technology Transfer Center Program
c. Generally accepted treatment outcome measures.
d. Methods for evaluating treatment progress.
e. Methods for assessing client’s motivation and adherence to
treatment plans.
f. Theories and principles of the stages of change and recovery.
Skills
a.
b.
c.
d.
e.
Identifying and documenting change.
Assessing adherence to treatment plans.
Applying treatment outcome measures.
Communicating with people of other cultures.
Reinforcing positive change.
Attitudes
a. Appreciation for cultural issues that impact treatment progress.
b. Respect for individual differences.
c. Therapeutic optimism.
3. Assess treatment and recovery progress and, in consultation
with the client and significant others, make appropriate
changes to the treatment plan to ensure progress toward
treatment goals.
Knowledge
a.
b.
c.
d.
e.
f.
Continuum of care.
Interviewing techniques.
Stages in the treatment and recovery process.
Individual differences in the recovery process.
Methods for evaluating treatment progress.
Methods for re-involving the client in the treatment planning
process.
Skills
a. Participating in conflict resolution, problem solving, and
mediation.
b. Observing, recognizing, assessing, and documenting client
progress.
c. Eliciting client perspectives on progress.
d. Demonstrating clear and concise written and verbal
communication.
e. Interviewing individuals, groups, and families.
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IV. Service Coordination
National Curriculum Committee
f. Acquiring and prioritizing relevant treatment information.
g. Assisting the client in maintaining motivation.
h. Maintaining contact with client, referral sources, and significant
others.
Attitudes
a. Willingness to be flexible.
b. Respect for the client’s right to self-determination.
c. Appreciation of the role significant others play in the recovery
process.
d. Appreciation of individual differences in the recovery process.
4. Describe and document treatment process, progress, and
outcome.
Knowledge
a.
b.
c.
d.
Treatment modalities.
Documentation of process, progress, and outcome.
Factors affecting client’s success in treatment.
Treatment planning.
Skills
a. Demonstrating clear and concise oral and written
communication.
b. Observing and assessing client progress.
c. Engaging client in the treatment process.
d. Applying progress and outcome measures.
Attitudes
a. Appreciation of the importance of accurate documentation.
b. Recognition of the importance of multidisciplinary treatment
planning.
5. Use accepted treatment outcome measures.
Knowledge
a. Treatment outcome measures.
b. Understand concepts of validity and reliability of outcome
measures.
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Addiction Technology Transfer Center Program
Skills
a. Using outcome measures in the treatment planning process.
Attitudes
a. Appreciation of the need to measure outcomes.
6. Conduct continuing care, relapse prevention, and discharge
planning with the client and involved significant others.
Knowledge
a.
b.
c.
d.
e.
f.
g.
h.
Treatment planning process.
Continuum of care.
Available social and family systems for continuing care.
Available community resources for continuing care.
Signs and symptoms of relapse.
Relapse prevention strategies.
Family and social systems theories.
Discharge planning process.
Skills
a. Accessing information from referral sources.
b. Demonstrating clear and concise oral and written
communication.
c. Assessing and documenting treatment progress.
d. Participating in confrontation, conflict resolution, and problem
solving.
e. Collaborating with referral sources.
f. Engaging client and significant others in treatment process and
continuing care.
g. Assisting client to develop a relapse prevention plan.
Attitudes
a. Therapeutic optimism.
b. Patience and perseverance.
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IV. Service Coordination
National Curriculum Committee
7. Document service coordination activities throughout the
continuum of care.
Knowledge
a. Documentation requirements including, but not limited to:
- addiction counseling,
- other disciplines,
- funding sources,
- agencies and service providers.
b. Service coordination role in the treatment process.
Skills
a. Demonstrating clear and concise written communication.
b. Using appropriate technology to report information in an
accurate and timely manner within the bounds of confidentiality
regulations.
Attitudes
a. Acceptance of documentation as an integral part of the
treatment process.
b. Willingness to use appropriate technology.
8. Apply placement, continued stay, and discharge criteria for
each modality on the continuum of care.
Knowledge
a.
b.
c.
d.
e.
Treatment planning along the continuum of care.
Initial and on-going placement criteria.
Methods to assess current and on-going client status.
Stages of progress associated with treatment modalities.
Appropriate discharge indicators.
Skills
a. Observing and assessing client progress.
b. Demonstrating clear and concise written and verbal
communication.
c. Participating in conflict resolution, problem solving, mediation,
and negotiation.
d. Tailoring treatment to meet client needs.
e. Applying placement, continued stay, and discharge criteria.
Addiction Counseling Competencies
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Addiction Technology Transfer Center Program
Attitudes
a. Confidence in client’s ability to progress within a continuum of
care.
b. Appreciation for the fair and objective use of placement,
continued stay, and discharge criteria.
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IV. Service Coordination
National Curriculum Committee
V. COUNSELING
A collaborative process that facilitates the client’s progress toward
mutually determined treatment goals and objectives. Counseling
includes methods that are sensitive to individual client characteristics
and to the influence of significant others, as well as the client’s cultural
and social context. Competence in counseling is built upon an
understanding of, appreciation of, and ability to appropriately use the
contributions of various addiction counseling models as they apply to
modalities of care for individuals, groups, families, couples, and
significant others.
A. Individual Counseling
1. Establish a helping relationship with the client characterized
by warmth, respect, genuineness, concreteness, and
empathy.
Knowledge
a. Theories, research, and best-practice literature.
b. Approaches to counseling that have demonstrated
effectiveness with substance use disorders.
c. Definitions of warmth, respect, genuineness, concreteness, and
empathy.
d. Role of the counselor.
e. Therapeutic uses of power and authority.
f. Transference, counter-transference, and projective
identification.
Skills
a. Active listening, including paraphrasing, reflecting, and
summarizing.
b. Conveying warmth, respect, and genuineness in a culturally
appropriate manner.
c. Demonstrating empathic understanding.
d. Using power and authority appropriately in support of treatment
goals.
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Addiction Technology Transfer Center Program
Attitudes
a. Respect for the client.
b. Recognition of the importance of cooperation and collaboration
with the client.
c. Professional objectivity.
2. Facilitate the client’s engagement in the treatment and
recovery process.
Knowledge
a. Theory and research related to client motivation.
b. Alternative theories and methods for motivating clients in a
culturally appropriate manner.
c. Theory, research, and best practice literature.
d. Counseling strategies that promote and support successful
client engagement.
e. Stages-of-change models used in engagement and treatment
strategies.
f. Client’s culture.
Skills
a. Implementing appropriate engagement and interviewing
approaches.
b. Assessing client readiness for change.
c. Using culturally appropriate counseling strategies.
d. Assessing the client’s responses to therapeutic interventions.
Attitudes
a. Respect for the client’s frame of reference.
3. Work with the client to establish realistic, achievable goals
consistent with achieving and maintaining recovery.
Knowledge
a. Assessment and treatment planning.
b. Stages of change and recovery.
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V. Counseling
National Curriculum Committee
Skills
a. Formulating and documenting concise, descriptive, and
measurable treatment outcome statements.
b. Teaching the client to identify goals and formulate action plans.
Attitudes
a. Appreciation for the client’s resources and preferences.
b. Appreciation for individual differences in the treatment and
recovery process.
4. Promote client knowledge, skills, and attitudes that contribute
to a positive change in substance use behaviors.
Knowledge
a. The information, skills, and attitudes consistent with recovery.
b. Client’s goals, treatment plan, prognosis, and motivational level.
c. Assessment methods to measure progress toward positive
change.
Skills
a. Motivational techniques.
b. Recognizing client strengths.
c. Assessing and providing feedback on client progress toward
treatment goals.
d. Assessing life and basic skills and comprehension levels of
client and all significant others associated with the treatment
plan.
e. Identification and documentation of change.
f. Coaching, mentoring, and teaching.
g. Recognizing and addressing ambivalence and resistance.
Attitudes
a. Genuine care and concern for client, family, and significant
others.
b. Appreciation for incremental change.
c. Patience and perseverance.
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Addiction Technology Transfer Center Program
5. Encourage and reinforce client actions determined to be
beneficial in progressing toward treatment goals.
Knowledge
a. Counseling theory, treatment, and practice literature as it
applies to substance use disorders.
b. Relapse prevention theory, practice, and outcome literature.
c. Behaviors and cognition consistent with the development,
maintenance, and attainment of treatment goals.
d. Counseling treatment methods that support positive client
behaviors consistent with recovery.
Skills
a. Using behavioral and cognitive methods that reinforce positive
client behaviors.
b. Using objective observation and documentation.
c. Assessing and re-assessing client behaviors.
Attitudes
a. Therapeutic optimism.
b. Patience and perseverance.
c. Appreciation for incremental changes.
6. Work appropriately with the client to recognize and
discourage all behaviors inconsistent with progress toward
treatment goals.
Knowledge
a. Client history and treatment plan.
b. Client behaviors and cognition that are inconsistent with
recovery process.
c. Behavioral and cognitive therapy literature relevant to
substance use disorders.
d. Cognitive, behavioral, and pharmacological interventions
appropriate for relapse prevention.
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V. Counseling
National Curriculum Committee
Skills
a. Monitoring the client’s behavior for consistency with preferred
treatment outcomes.
b. Presenting inconsistencies between client behaviors and goals.
c. Re-framing and redirecting negative behaviors.
d. Conflict resolution, decision-making, and problem solving skills.
e. Recognizing and addressing underlying client issues that may
impede treatment progress.
Attitudes
a. Patience and perseverance during periods of treatment
difficulty.
b. Accepting relapse as an opportunity for positive change.
c. Recognizing the value of a constructive helping relationship.
7. Recognize how, when, and why to involve the client’s
significant others in enhancing or supporting the treatment
plan.
Knowledge
a. Theory, research, and outcome-based literature demonstrating
the importance of significant others, including families and other
social systems, to treatment progress.
b. Social and family systems theory.
c. How to apply appropriate confidentiality regulations.
Skills
a. Identifying the client’s family and social systems .
b. Recognizing the impact of the client’s family and social systems
on the treatment process.
c. Engaging significant others in the treatment process.
Attitudes
a. Appreciation for the need of significant others to be involved in
the client’s treatment plan, within the bounds of confidentiality.
b. Respect for the contribution of significant others to the
treatment process.
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Addiction Technology Transfer Center Program
8. Promote client knowledge, skills, and attitudes consistent
with the maintenance of health and prevention of human
immunodeficiency virus/acquired immune deficiency
syndrome (HIV/AIDS), tuberculosis (TB), sexually
transmitted diseases (STDs), and other infectious diseases.
Knowledge
a. Client and system worldviews relative to health..
b. How infectious diseases are transmitted and prevented.
c. The relationship between substance-abusing lifestyles and the
transmission of infectious diseases.
d. Harm reduction concepts, research, and methods.
Skills
a. Using a repertoire of techniques that, based on an assessment
of various client and system characteristics, will promote and
reinforce health-enhancing activities.
b. Coaching, mentoring, and teaching techniques relative to the
promotion and maintenance of health.
c. Demonstrating cultural competence in discussing sexuality.
Attitudes
a. Openness to discussions about health issues, lifestyle, and
sexuality.
b. Recognition of the counselor’s potential to model a healthy lifestyle.
9. Facilitate the development of basic and life skills associated
with recovery.
Knowledge
a. Basic and life skills associated with recovery.
b. Theory, research, and practice literature that examines the
relationship of basic and life skills to the attainment of positive
treatment outcomes.
c. Tools used to determine levels of basic and life skills.
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V. Counseling
National Curriculum Committee
Skills
a. Teaching life skills appropriate to the client’s situation and skill
level.
b. Applying assessment tools to determine the client’s level of
basic and life skills.
c. Communicating how basic and life skills relate to treatment
outcomes.
Attitudes
a. Recognizing that recovery involves a broader life context than
the elimination of symptoms.
b. Accepting relapse as an opportunity for learning and/or skills
acquisition..
10. Adapt counseling strategies to the individual
characteristics of the client, including but not limited to,
disability, gender, sexual orientation, developmental level,
culture, ethnicity, age, and health status.
Knowledge
a. Impact of culture on substance use.
b. Cultural factors affecting responsiveness to varying counseling
strategies.
c. Current research concerning differences in drinking and
substance use patterns based on the characteristics of the
client.
d. Addiction counseling strategies.
e. How to apply appropriate strategies based on the client’s
treatment plan.
f. Client’s family and social systems and relationships between
each.
g. Client and system’s cultural norms, biases, and preferences.
h. Literature relating spirituality to addiction and recovery.
Skills
a. Individualizing treatment plans.
b. Adapting counseling strategies to unique client characteristics
and circumstances.
c. Practicing cultural communication.
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Attitudes
a. Recognition of the need for flexibility in meeting client needs.
b. Willingness to adjust strategies in accordance with client’s
characteristics.
c. A non-judgmental, respectful acceptance of cultural, behavioral,
and value differences.
11. Make constructive therapeutic responses when client’s
behavior is inconsistent with stated recovery goals.
Knowledge
a.
b.
c.
d.
Client behaviors that tend to be inconsistent with recovery.
The client’s social and life circumstances.
Relapse prevention strategies.
Therapeutic interventions.
Skills
a. Monitoring client progress.
b. Using various methods to present inconsistencies between
client's behaviors and treatment goals.
c. Re-framing and redirecting negative behaviors.
d. Utilizing appropriate intervention strategies.
Attitudes
a. Therapeutic optimism.
b. Perseverance during periods of treatment difficulty.
12. Apply crisis management skills.
Knowledge
a. Differences between crisis intervention and other kinds of
therapeutic intervention.
b. Characteristics of a serious crisis and typical reactions.
c. Post-traumatic stress and other relevant psychiatric disorders.
d. Roles played by family and significant others in the crisis
development and/or reaction.
e. Relationship of crisis to client’s stage of change.
f. Client’s usual coping strategies.
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g. Steps to aid in crisis resolution, including determination of what
client can do on his/her own and what must be done by
counselor, family, or significant others in client system.
Skills
a. Carrying out steps in crisis resolution.
b. Assessing and engaging client and client system strengths and
resources.
c. Assessing for immediate concerns regarding safety and any
potential harm to others.
d. Making appropriate referrals as necessary.
e. Assessing and acting upon issues of confidentiality that may be
part of crisis response.
f. Assisting the client to ventilate emotions and normalize
feelings.
Attitudes
a. Recognize crisis as an opportunity for change.
b. Confidence in the midst of crisis.
c. Recognize personal and professional limitations.
13. Facilitate the client’s identification, selection, and practice of
strategies that help sustain the knowledge, skills, and
attitudes needed for maintaining treatment progress and
preventing relapse.
Knowledge
a. How the client and client’s family, significant others, mutualhelp support groups, and other systems can enhance and
maintain treatment progress, relapse prevention, and
continuing care.
b. Relapse prevention strategies.
c. Skills-training methods.
Skills
a. Using behavioral techniques to reinforce positive client
behaviors.
b. Teaching relapse prevention and life skills.
c. Motivating the client toward involvement in mutual-help support
groups.
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Attitudes
a. Recognize that clients must assume responsibility for their own
recovery.
B. GROUP COUNSELING
1. Describe, select, and appropriately use strategies from
accepted and culturally appropriate models for group
counseling with clients with substance use disorders.
Knowledge
a. A variety of group methods appropriate to achieving client
objectives in a treatment population.
b. Research concerning the effectiveness of varying models and
strategies for group counseling with general populations.
c. Research concerning the effectiveness of varying models and
strategies for populations with substance use disorders.
d. Research and theory concerning the effectiveness of varying
models and strategies for group counseling with members of
varying cultural groups.
e. Therapeutic use of humor.
Skills
a. Designing and implementing strategies to meet the needs of
specific groups.
b. Recognizing and accommodating appropriate individual needs
within the group.
c. Leading therapeutic groups for clients with substance use
disorders.
d. Using humor appropriately.
Attitudes
a. Openness and flexibility in the choice of counseling strategies
that meet needs of the group and the individuals within the
group.
b. Recognition of the value of the use of groups as an effective
therapeutic intervention.
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2. Carry out the actions necessary to form a group, including,
but not limited to: determining group type, purpose, size, and
leadership; recruiting and selecting members; establishing
group goals and clarifying behavioral ground rules for
participating; identifying outcomes; and determining criteria
and methods for termination or graduation from the group.
Knowledge
a. Specific group models and strategies relative to client’s age,
gender, cultural context.
b. Selection criteria, methods, and instruments for screening and
selecting group members.
c. General principles for selecting group goals, outcomes, and
ground rules.
d. General principles for appropriately graduating group members
and terminating groups.
Skills
a. Conducting screening interviews.
b. Assessing individual client’s appropriateness for participation in
group.
c. Using group process to negotiate group goals, outcomes, and
ground rules within the context of the individual needs and
objectives of group members.
d. Using group process to negotiate appropriate criteria and
methods for transition to the next appropriate level of care.
e. Adapting group counseling skills as appropriate for group type.
Attitudes
a. Recognition of the importance of involving group members in
the establishment of group goals, outcomes, ground rules, and
graduation and termination criteria.
b. Recognition of the fact that the nature of the specific group
model should depend on the needs, goals, outcomes, and
cultural context of the participants.
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3. Facilitate the entry of new members and the transition of
exiting members.
Knowledge
a. Developmental processes affecting therapeutic groups over
time.
b. Issues faced by individuals and the group as a whole upon
entry of new members.
c. Issues faced by individuals and by the group as a whole upon
exit of members.
d. Characteristics of transition stages in therapeutic groups.
e. Characteristics of therapeutic group behavior.
Skills
a. Using group process to prepare group members for transition
and to resolve transitional issues.
b. Effectively dealing with different types of resistant behaviors,
transference, and countertransference issues.
c. Recognizing when members are ready to exit.
Attitudes
a. Recognition of the need to balance individual needs with group
needs, goals, and outcomes.
b. Appreciation for the contribution of new and continuing group
members in the group process.
c. Maintaining non-judgmental attitudes and behaviors.
d. Respect for the emotional experience of the entry and exit of
group members on the rest of the group.
4. Facilitate group growth within the established ground rules
and movement toward group and individual goals by using
methods consistent with group type.
Knowledge
a. Leadership, facilitator, and counseling methods appropriate for
each group type and therapeutic setting.
b. Types and uses of power and authority in therapeutic group
process.
c. Stages of group development and counseling methods
appropriate to each stage.
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Skills
a. Applying group counseling methods leading to measurable
progress toward group and individual goals and outcomes.
b. Recognizing when and how to use appropriate power.
c. Documenting measurable progress toward group and individual
goals.
Attitudes
a. Recognition of the value of the use of different group
counseling methods and leadership or facilitation styles.
b. Appreciation for the role and power of the group facilitator.
c. Appreciation for the role and power of various group members
in the group process.
5. Understand the concepts of process and content, and shift
the focus of the group when such an intervention will help the
group move toward its goals.
Knowledge
a. Definitions of the concepts of process and content.
b. Difference between the group process and the content of the
discussion.
c. Methods and techniques of group problem solving, decisionmaking, and addressing group conflict.
d. How process variables affect the group’s ability to focus on
content concerns.
e. How content variables affect the group’s ability to focus on
process concerns.
Skills
a. Observing and documenting process and content.
b. Assessing when to make appropriate process interventions.
c. Using strategies congruent with enhancing both process and
content in order to meet individual and group goals.
Attitudes
a. Appreciating the appropriate use of content and process
interventions.
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6. Describe and summarize client behavior within the group for
the purpose of documenting the client’s progress and
identifying needs and issues that may require a modification
in the treatment plan.
Knowledge
a. How individual treatment issues may surface within the context
of group process.
b. Situations in which significant differences between individual
and group goals require changing either the individual’s goals
or the group’s focus.
Skills
a. Recognizing that a client’s behavior can be, but is not always,
reflective of the client’s treatment needs.
b. Documenting client’s group behavior that has implications for
treatment planning.
c. Recognizing the similarities and differences between individual
needs and group processes.
d. Redesigning individual treatment plans based on the
observation of group behaviors.
Attitudes
a. Recognition of the value of accurate documentation.
b. Appreciation of individual differences in rates of progress
towards treatment goals and use of group intervention.
C. COUNSELING FAMILIES, COUPLES, AND
SIGNIFICANT OTHERS
1. Understand the characteristics and dynamics of families,
couples, and significant others affected by substance use.
Knowledge
a. Dynamics associated with substance use, abuse, and
dependence in families, couples, and significant others.
b. Impact of interaction patterns on substance use behaviors.
c. Cultural factors related to the impact of substance use
disorders on families, couples, and significant others.
d. Systems theory and dynamics.
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e. Signs and patterns of domestic violence.
f. Impacts of substance use behaviors on interaction patterns.
Skills
a. Identifying systemic interactions that are likely to affect
recovery.
b. Recognizing the roles of significant others within the client’s
social system.
c. Recognizing potential for and signs and symptoms of domestic
violence.
Attitudes
a. Recognition of non-constructive family behaviors as systemic
issues.
b. Appreciation of the role systemic interactions plays in
substance use behavior.
c. Appreciation for diverse cultural factors that influence
characteristics and dynamics of families, couples and
significant others.
2. Be familiar with and appropriately use models of diagnosis
and intervention for families, couples, and significant others,
including extended, kinship, or tribal family structures.
Knowledge
a. Intervention strategies appropriate for systems at varying
stages of problem development and resolution.
b. Intervention strategies appropriate for violence against persons.
c. Laws and resource regarding violence against persons.
d. Culturally appropriate family intervention strategies.
e. Appropriate and available assessment tools for use with
families, couples, and significant others.
Skills
a. Applying assessment tools for use with families, couples, and
significant others.
b. Applying culturally appropriate intervention strategies.
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Attitudes
a. Recognition of the validity of viewing the system as the client,
while respecting the rights and needs of individuals.
b. Appreciation for the diversity found in families, couples, and
significant others.
3. Facilitate the engagement of selected members of the family,
couple, or significant others in the treatment and recovery
process.
Knowledge
a. How to apply appropriate confidentiality regulations.
b. Methods for engaging members of the family, couple, or
significant others to focus on their own concerns when the
substance abuser is not ready to participate.
Skills
a. Working within the bounds of confidentiality regulations.
b. Identifying goals based on both individual and systemic
concerns.
c. Using appropriate therapeutic interventions with system
members that address established treatment goals.
Attitudes
a. Recognition of the usefulness of working with those individual
systems members who are personally ready to participate in the
counseling process.
b. Respect for confidentiality regulations.
4. Assist families, couples, and significant others to understand
the interaction between the family system and substance use
behaviors.
Knowledge
a. The impact of family interaction patterns on substance use.
b. The impact of substance use on family interaction patterns.
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c. Theory and research literature outlining systemic interventions
in psychoactive substance abuse situations, including violence
against persons.
Skills
a. Describing systemic issues constructively to families, couples,
and significant others.
b. Teaching system members to identify and interrupt harmful
interaction patterns.
c. Helping system members practice and evaluate alternate
interaction patterns.
Attitudes
a. Appreciation for the complexities of counseling families,
couples, and significant others.
5. Assist families, couples, and significant others to adopt
strategies and behaviors that sustain recovery and maintain
healthy relationships.
Knowledge
a. Healthy behavioral patterns for families, couples, and
significant others.
b. Empirically based systemic counseling strategies associated
with recovery.
c. Stages of recovery for families, couples, and significant others.
Skills
a. Assisting system members to identify and practice behaviors
designed to resolve the crises brought about by changes in
substance use behaviors.
b. Assisting family members to identify and practice behaviors
associated with long-term maintenance of healthy interactions.
Attitudes
a. Appreciation for a variety of approaches in working with
families, couples, and significant others.
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VI. CLIENT, FAMILY, AND
COMMUNITY EDUCATION
The process of providing clients, families, significant others, and
community groups with information on risks related to psychoactive
substance use, as well as available prevention, treatment and
recovery resources.
1. Provide culturally relevant formal and informal education
programs that raise awareness and support substance
abuse prevention and/or the recovery process.
Knowledge
a. Cultural differences among ethnically and racially diverse
communities.
b. Cultural differences in consumption of psychoactive
substances.
c. Delivery of educational programs.
d. Research and theory on prevention of substance abuse
problems.
e. Learning styles and teaching methods.
f. Public speaking.
Skills
a.
b.
c.
d.
Delivering prevention and treatment educational programs.
Facilitating discussion.
Preparing outlines and handout materials.
Making public presentations.
Attitudes
a. Awareness of and sensitivity to cultural differences.
b. Appreciation of the difference between educating and providing
information.
c. Appreciating the historical, social, cultural, and other influences
that shape the perceptions of psychoactive substance use.
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2. Describe factors that increase the likelihood for an individual,
community, or group to be at-risk for, or resilient to,
psychoactive substance use disorders.
Knowledge
a.
b.
c.
Skills
a.
Individual, community, and group risk and resiliency factors.
Social issues influencing the development of substance abuse.
Environmental influences on risk and resiliency.
Describing individual, community, and group risk and resiliency
factors.
Attitudes
a. Sensitivity to individual, community, and group differences in
the risk for development of substance use disorders.
b. Non-judgmental presentation of issues.
3. Sensitize others to issues of cultural identity, ethnic
background, age, and gender in prevention, treatment, and
recovery.
Knowledge
a. Cultural issues in planning prevention and treatment programs.
b. Age and gender differences in psychoactive substance use.
c. Culture, gender, and age-appropriate prevention, treatment,
and recovery resources.
Skills
a. Communicating effectively with diverse populations.
b. Providing educational programs that reflect understanding of
culture, ethnicity, age, and gender.
Attitudes
a. Sensitivity to the role of culture, ethnicity, age, and gender in
prevention, treatment, and recovery.
b. Awareness of one’s own cultural biases.
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4. Describe warning signs, symptoms, and the course of
substance use disorders.
Knowledge
a. The continuum of use and abuse, including the warning signs
and symptoms of a developing substance use disorder.
b. Role of public policy in prevention and treatment of substance
use disorders.
c. Current DSM categories or other diagnostic standards
associated with psychoactive substance use.
Skills
a. Identifying and teaching signs and symptoms of various
substance use disorders.
b. Facilitating discussions that outline the warning signs and
symptoms of various substance use disorders.
Attitudes
a. Recognition of the importance of research in prevention and
treatment.
5. Describe how substance use disorders affect families and
concerned others.
Knowledge
a. How psychoactive substance use by one family member affects
other family members or significant others.
b. The family’s potential positive or negative influence on the
development and continuation of a substance use disorder.
c. The role of the family, couple, or significant other in treatment
and recovery.
Skills
a. Educating clients, families, and the community about the impact
of substance use disorders on the family, couple, or significant
others.
Attitudes
a. Recognition of the unique response of family members and
significant others to substance use disorders.
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6. Describe the continuum of care and resources available to
family and concerned others.
Knowledge
a. The continuum of care.
b. Available treatment resources, including local health, allied
health, and behavioral health resources.
Skills
a. Motivating both family members and clients to seek care.
b. Describing different treatment modalities and the continuum of
care.
c. Identifying and making referrals to local health, allied health,
and behavioral health resources.
Attitudes
a. Patience and perseverance.
b. Appreciation of the difficulty for families and significant others to
seek help.
c. Appreciation of ethnic and cultural differences.
7. Describe principles and philosophy of prevention, treatment,
and recovery.
Knowledge
a. Models for prevention, treatment, and recovery from substance
use disorders.
b. Research and theory on models of prevention, treatment, and
recovery.
c. Influences on societal and political responses to substance use
disorders.
Skills
a. Organizing and delivering presentations that reflect basic
information on prevention, treatment, and recovery.
Attitudes
a. Appreciation of the importance of prevention and treatment.
b. Recognition of the validity of a variety of prevention and
treatment strategies.
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8. Understand and describe the health and behavior problems
related to substance use, including transmission and
prevention of HIV/AIDS, TB, STDs, and other infectious
diseases.
Knowledge
a.
b.
c.
d.
Health risks associated with substance use.
High-risk behaviors related to substance use.
Prevention and transmission of infectious diseases.
Factors that may be associated with the prevention or
transmission of infectious diseases.
e. Community health and allied health resources.
Skills
a. Teaching clients and community members about disease
transmission and prevention.
b. Facilitating small and large group discussions.
Attitudes
a. Awareness of one’s own biases when presenting this
information.
9. Teach life skills, including but not limited to, stress
management, relaxation, communication, assertiveness, and
refusal skills.
Knowledge
a. The importance of life skills to the prevention and treatment of
substance use disorders.
b. How these skills are typically taught to individuals and groups.
c. Local resources available to teach these skills.
Skills
a. Implementing training sessions.
b. Identifying and accessing other instructional resources for
training.
Attitudes
a. Recognition of the importance of life skills training to the
process of recovery.
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VII. DOCUMENTATION
The recording of the screening and intake process, assessment,
treatment plan, clinical reports, clinical progress notes, discharge
summaries, and other client-related data.
1. Demonstrate knowledge of accepted principles of client
record management.
Knowledge
a. Regulations pertaining to client records.
b. The essential components of client records, including release
forms, assessments, treatment plans, progress notes, and
discharge summaries and plans.
Skills
a. Composing timely, clear, and concise records that comply with
regulations.
b. Documenting information in an objective manner.
c. Writing legibly.
d. Utilizing new technologies in the production of client records.
Attitudes
a. Appreciation of the importance of accurate documentation.
2. Protect client rights to privacy and confidentiality in the
preparation and handling of records, especially in relation to
the communication of client information with third parties.
Knowledge
a.
b.
c.
d.
Program, State, and Federal confidentiality regulations.
The application of confidentiality regulations.
Confidentiality regulations regarding infectious diseases.
The legal nature of records.
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Skills
a. Applying Federal, State, and agency regulations regarding
client confidentiality.
b. Requesting, preparing, and completing release of information
when appropriate.
c. Protecting and communicating client rights.
d. Explaining regulations to clients and third parties.
e. Applying infectious disease regulations as they relate to
addictions treatment.
f. Providing security for clinical records.
Attitudes
a. Willingness to seek and accept supervision regarding
confidentiality regulations.
b. Respect for the client's right to privacy and confidentiality.
c. Commitment to professionalism.
d. Recognition of the absolute necessity of safeguarding records.
3. Prepare accurate and concise screening, intake, and
assessment reports.
Knowledge
a. Essential elements of screening, intake, and assessment
reports, including, but not limited to:
-psychoactive substance use and abuse history,
-physical health,
-psychological information,
-social information,
-history of criminality,
-spiritual information,
-recreational information,
-nutritional information,
-educational and/or vocational information,
-sexual information,
-legal information.
Skills
a. Analyzing, synthesizing, and summarizing information.
b. Recording information that is concise and relevant.
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Attitudes
a. Willingness to develop accurate reports.
b. Recognition of the importance of accurate records.
4. Record treatment and continuing care plans that are
consistent with agency standards and comply with applicable
administrative rules.
Knowledge
a. Current Federal, State, local, and program regulations.
b. Regulations regarding informed consent.
Skills
a. Documenting timely, clear, and concise records that comply
with regulations.
Attitudes
a. Recognition of the importance of recording treatment and
continuing care plans.
5. Record progress of client in relation to treatment goals and
objectives.
Knowledge
a. Appropriate clinical terminology used to describe client
progress.
b. How to review and update records.
Skills
a. Preparing clear and legible documents.
b. Documenting changes in the treatment plan.
c. Using appropriate clinical terminology.
Attitudes
a. Recognition of the value of objectively recording progress.
b. Recognition that timely recording is critical to accurate
documentation.
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6. Prepare accurate and concise discharge summaries.
Knowledge
a. The components of a discharge summary, including but not
limited to:
- client profile and demographics,
- presenting symptoms,
- diagnoses,
- selected interventions,
- critical incidents,
- progress toward treatment goals,
- outcome,
- aftercare plan,
- prognosis,
- recommendations.
Skills
a.
b.
c.
d.
Summarizing information.
Preparing concise discharge summaries.
Completing timely records.
Reporting measurable results.
Attitudes
a. Recognition that treatment is not a static, singular event.
b. Recognition that recovery is ongoing.
c. Recognition that timely recording is critical to accurate
documentation.
7. Document treatment outcome, using accepted methods and
instruments.
Knowledge
a.
b.
c.
d.
e.
Accepted measures of treatment outcome.
Current research related to defining treatment outcomes.
Methods of gathering outcome data.
Principles of using outcome data for program evaluation.
Distinctions between process and outcome evaluation.
Skills
a. Gathering and recording outcome data.
b. Incorporating outcome measures during the treatment process.
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Attitudes
a. Recognition that treatment and evaluation should occur
simultaneously.
b. Appreciation of the importance of using data to improve clinical
practice.
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VIII. PROFESSIONAL AND
ETHICAL RESPONSIBILITIES
The obligations of an addiction counselor to adhere to accepted
ethical and behavioral standards of conduct and continuing
professional development.
1. Adhere to established professional codes of ethics that
define the professional context within which the counselor
works, in order to maintain professional standards and
safeguard the client.
Knowledge
a.
b.
c.
d.
e.
f.
g.
h.
i.
Federal, State, agency, and professional codes of ethics.
Client rights and responsibilities.
Professional standards and scope of practice.
Boundary issues between client and counselor.
Difference between the role of the professional counselor and
that of a peer counselor or sponsor.
Consequences of violating codes of ethics.
Means for addressing alleged ethical violations.
Non-discriminatory practices.
Mandatory reporting requirements.
Skills
a. Demonstrating ethical and professional behavior.
Attitudes
a. Openness to changing personal behaviors and attitudes that
may conflict with ethical guidelines.
b. Willingness to participate in self, peer, and supervisory
assessment of clinical skills and practice.
c. Respect for professional standards.
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2. Adhere to Federal and State laws and agency regulations
regarding the treatment of substance use disorders.
Knowledge
a. Federal, State, and agency regulations that apply to addiction
counseling.
b. Confidentiality regulations.
c. Client rights and responsibilities.
d. Legal ramifications of non-compliance with confidentiality
regulations.
e. Legal ramifications of violating client rights.
f. Grievance processes.
Skills
a. Interpreting and applying appropriate Federal, State, and
agency regulations regarding addiction counseling.
b. Making ethical decisions that reflect unique needs and
situations.
c. Providing treatment services that conform to Federal, State,
and local regulations.
Attitudes
a. Appreciation of the importance of complying with Federal,
State, and agency regulations.
b. Willingness to learn appropriate application of Federal, State,
and agency guidelines.
3. Interpret and apply information from current counseling and
psychoactive substance use research literature to improve
client care and enhance professional growth.
Knowledge
a.
b.
c.
d.
Professional literature on substance use disorders.
Information on current trends in addiction and related fields.
Professional associations.
Resources to promote professional growth and competency.
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Skills
a. Reading and interpreting current professional and researchbased literature.
b. Applying professional knowledge to client-specific situations.
c. Applying research findings to clinical practice.
d. Applying new skills in clinically appropriate ways.
Attitudes
a. Interest in expanding one’s own knowledge and skills base.
b. Willingness to adjust clinical practice to reflect advances in the
field.
4. Recognize the importance of individual differences that
influence client behavior and apply this understanding to
clinical practice.
Knowledge
a. Differences found in diverse populations.
b. How individual differences impact assessment and response to
treatment.
c. Personality, culture, lifestyle, and other factors influencing client
behavior.
d. Culturally sensitive counseling methods.
e. Dynamics of family systems in diverse cultures and lifestyles.
f. Client advocacy needs specific to diverse cultures and
lifestyles.
g. Signs, symptoms, and patterns of violence against persons.
h. Risk factors that relate to potential harm to self or others.
i. Hierarchy of needs and motivation.
Skills
a. Assessing and interpreting culturally specific client behaviors
and lifestyle.
b. Conveying respect for cultural and lifestyle diversity in the
therapeutic process.
c. Adapting therapeutic strategies to client needs.
Attitudes
a. Willingness to appreciate the life experiences of individuals.
b. Appreciation for diverse populations and lifestyles.
c. Recognition of one’s own biases towards other cultures and
lifestyles.
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5. Utilize a range of supervisory options to process personal
feelings and concerns about clients.
Knowledge
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
The role of supervision.
Models of supervision.
Potential barriers in the counselor and client relationship.
Transference and countertransference.
Resources for exploration of professional concerns.
Problem-solving methods.
Conflict resolution.
The process and impact of client reassignment.
The process and impact of termination of the counseling
relationship.
Phases of treatment and client responses.
Skills
a.
b.
c.
d.
e.
Recognizing situations in which supervision is appropriate.
Developing a plan for resolution or improvement.
Seeking supervisory feedback.
Resolving conflicts.
Identifying overt and covert feelings and their impact on the
counseling relationship.
f. Communicating feelings and concerns openly and respectfully.
Attitudes
a. Willingness to accept feedback.
b. Acceptance of responsibility for personal and professional
growth.
c. Awareness that one’s own personal recovery issues have an
impact on job performance and interactions with clients.
6. Conduct self-evaluations of professional performance
applying ethical, legal, and professional standards to
enhance self-awareness and performance.
Knowledge
a. Personal and professional strengths and limitations.
b. Legal, ethical, and professional standards affecting addiction
counseling.
c. Consequences of failure to comply with professional standards.
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d. Self-evaluation methods.
e. Regulatory guidelines and restrictions.
Skills
a. Developing professional goals and objectives.
b. Interpreting and applying ethical, legal, and professional
standards.
c. Using self-assessment tools for personal and professional
growth.
d. Eliciting and applying feedback from colleagues and
supervisors.
Attitudes
a. Appreciation of the importance of self-evaluation.
b. Recognition of personal strengths, weaknesses, and limitations.
c. Willingness to change behaviors as necessary.
7. Obtain appropriate continuing professional education.
Knowledge
a. Education and training methods that promote professional
growth.
b. Recredentialing requirements.
Skills
a. Assessing personal training needs.
b. Selecting and participating in appropriate training programs.
c. Using consultation and supervision as an enhancement to
professional growth.
Attitudes
a. Recognition that professional growth continues throughout
one's professional career.
b. Willingness to expose oneself to information that may conflict
with personal and/or professional beliefs.
c. Recognition that professional development is an individual
responsibility.
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National Curriculum Committee
8. Participate in ongoing supervision and consultation.
Knowledge
a. The rationale for regular assessment of professional skills and
development.
b. Models of clinical and administrative supervision.
c. The rationale for using consultation.
d. Agency policy and protocols.
e. Case presentation methods.
f. How to identify needs for clinical or technical assistance.
g. Interpersonal dynamics in a supervisory relationship.
Skills
a.
b.
c.
d.
Identifying professional progress and limitations.
Communicating the need for assistance.
Preparing and making case presentations.
Eliciting feedback from others.
Attitudes
a. Willingness to accept both constructive criticism and positive
feedback.
b. Respect for the value of clinical and administrative supervision.
9. Develop and utilize strategies to maintain one’s own physical
and mental health.
Knowledge
a. Rationale for periodic self-assessment regarding physical and
mental health.
b. Available resources for maintaining physical and mental health.
c. Consequences of failing to maintain physical and mental health.
d. Relationship between physical and mental health.
e. Health promotion strategies.
Skills
a. Carrying out regular self-assessment with regards to physical
and mental health.
b. Using prevention measures to guard against burnout.
c. Employing stress reduction strategies.
d. Locating and accessing resources to achieve physical and
mental health.
e. Modeling self-care as an effective treatment tool.
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Attitudes
a. Recognition that counselors serve as role models.
b. Appreciation that maintaining a healthy lifestyle enhances the
counselor’s effectiveness.
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Appendix A
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Appendix B
Glossary of Terms
1. Addiction Counseling: professional and ethical application of basic tasks and
responsibilities which include clinical evaluation; treatment planning; referral; service
coordination; client, family, and community education; client, family, and group
counseling; and documentation.
2. Addiction: the overpowering physical or emotional urge to continue alcohol/drug
use in spite of adverse consequences; there is an increase in tolerance for the drug
and withdrawal symptoms sometimes occur if the drug is discontinued; alcohol and
drugs become the central focus of life.
3. Bio-medical: the application of the natural sciences, especially biological and
physiological sciences, to clinical medicine.
4. Case Management: see “Service Coordination.”
5. Client: individuals, significant others, or community agents who present for alcohol
and drug abuse education, prevention, intervention, treatment, and consultation
services.
6. Competency: the requisite knowledge, skills, and attitudes to perform tasks and
responsibilities essential to addiction counseling.
7. Confidentiality: the body of Federal and State statutes that protect the privacy of
individuals seeking alcohol and drug abuse treatment services.
8. Continuum of Care: the full array of alcohol and drug abuse services responsive to
the unique needs of clients throughout the course of treatment and recovery.
9. Counseling: a process involving a therapeutic relationship between a client who is
asking for help and a counselor or therapist trained to provide that help.
10. Countertransference: a counselor’s unresolved feelings for significant others that
may be transferred to the client.
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11. Cultural Diversity: an appreciation and recognition of the vast array of different
cultural groups based on varying behaviors, attitudes, values, languages, celebrations,
rituals, and histories; diversity as it relates to culture includes actions taken by
individuals, organizations, and communities to reflect inclusion and representation of
diverse groups.
12. Culture: the vast structure of behaviors, ideas, attitudes, values, habits, beliefs,
customs, language, rituals, ceremonies, histories, and practices distinctive to a
particular group of people.
13. Dimension: the eight essential areas of practice which addiction counselors must
master to effectively provide treatment activities identified in “Addiction Counseling
Competencies.”
14. Disorder: an affliction that affects the functions of the mind and/or body, disturbing
physical and/or mental health.
15. Dual Disorder: the condition of being both substance dependent and having a
major Axis I psychiatric diagnosis as defined in the most recent edition of the
“Diagnostic and Statistical Manual of Mental Disorders” (DSM).
16. Duty to Warn: the legal obligation of a counselor (healthcare provider) to notify the
appropriate authorities as defined by statute and/or the potential victim when there is
serious danger of a client inflicting injury on an identified individual.
17. Element: specific, definable areas found in three of the practice dimensions
(Clinical Evaluation, Service Coordination, and Counseling).
18. Harmful Use: patterns of use of alcohol or other drugs for non-medical reasons
that result in health consequences and some degree of impairment in social,
psychological, and occupational functioning for the user.
19. Infectious: transmission of an illness or disease by direct or indirect contact.
20. Managed Care: an approach to delivering health and mental health services to
clients that seeks to improve the cost effectiveness of care by monitoring access and
utilization of medical services and supplies, and the outcomes of that care.
21. Multi-Disciplinary: a planned and coordinated program of care involving two or
more health professions for the purpose of improving health care as a result of their
joint contributions.
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22. Outcome Monitoring: collection and analysis of data during and following alcohol
and other drug treatment to determine the effects of treatment, especially in relation to
improvements in client functioning.
23. Patient: see “Client.”
24. Prevention: the theory and means for reducing the harmful effects of drug use in
specific populations. Prevention objectives are to protect individuals prior to signs or
symptoms of substance use problems; to identify persons in the early stages of
substance abuse and intervene; and to end compulsive use of psychoactive
substances through treatment.
25. Professionalism: a demonstration of knowledge, skills, and attitudes consistently
applied when working with substance users, in addition to maintaining the code of
ethics most commonly held by addictions professionals.
26. Psychoactive Substance: a pharmacological agent that can change mood,
behavior, and cognition process.
27. Recovery: achieving and sustaining a state of health in which the individual no
longer engages in problematic behavior or psychoactive substance use, and is able to
establish and accomplish goals.
28. Regression: a defense mechanism in which an individual retreats to the use of
primitive or less mature responses in attempting to cope with stress, fears, or pain.
29. Relapse: the return to the pattern of substance abuse as well as the process during
which indicators appear prior to the client’s resumption of substance use.
30. Service Coordination: the process of prioritizing, managing, and facilitating
implementation of activities in an individual’s treatment plan.
31. Significant Others: sexual partner, family member, or others on whom an
individual is dependent for meeting all or part of his or her needs.
32. Sobriety: the quality or condition of abstinence from psychoactive substance
abuse.
33. Special Populations: diverse groups of individuals having a unique culture,
heritage, and background.
34. Spirituality: a belief system that acknowledges and appreciates the influence in
one’s life of a higher power or state of being.
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35. Substance Abuse: a maladaptive pattern of substance use leading to clinically
significant impairment or distress such as failure to fulfill major role responsibilities, use
in spite of physical hazards, legal problems, or interpersonal and social problems. (Also
refer to the most recent edition of the “Diagnostic and Statistical Manual of Mental
Disorders”)
36. Substance Dependence: the need for alcohol or other drugs that results from the
use of that substance. This need includes both mental and physical changes which
makes it difficult for the user to control when they will use the substance and how much
they will use. Psychological dependence occurs when the user needs the substance to
feel good, normal, or to function. Physical dependence occurs when the body adapts
to the substance and needs increasing amounts to achieve the same effect or to
function. (Also refer to the most recent edition of the “Diagnostic and Statistical Manual
of Mental Disorders”)
37. Substance Use: consumption of low and/or infrequent doses of alcohol and other
drugs, sometimes called “experimental,” “casual,” or “social” use, such that damaging
consequences may be rare or minor.
38. Supervision/Clinical Supervision: the administrative, clinical, and evaluative
process of monitoring, assessing, and enhancing counselor performance.
39. Transdisciplinary: knowledge, skills, and attitudes across academic disciplines
related to substance abuse.
40. Transference: a client’s unresolved feeling for significant others that may be
transferred to the counselor.
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Appendix C
Addiction Counseling Competencies
In 1995 the National Curriculum Committee of the Addiction Technology
Transfer Center Program published the original work entitled Addiction Counselor
Competencies. This work represented the Committee=s first attempt to describe the
knowledge, skills, and attitudes that characterize competent practice in addictions
counseling. The document was met with widespread enthusiasm and has been used
by a variety of colleges, universities, and other groups as a basis of development for
counselor training programs.
As the Committee continued its work to establish the actual knowledge, skills,
and attitudes statements that are contained in this publication, the original work
underwent a series of transformations and changes. As a result, the revised Addiction
Counseling Competencies is being presented in its entirety here in Appendix C.
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Section 1
I. TRANSDISCIPLINARY FOUNDATIONS
The following knowledge and attitudes are prerequisite to the development
of competency in the professional treatment of substance use disorders.
Such knowledge and attitudes form the basis of understanding upon which
discipline-specific proficiencies are built.
A. UNDERSTANDING ADDICTION
1. Understand a variety of models and theories of addiction and
other problems related to substance use.
2. Recognize the social, political, economic, and cultural
context within which addiction and substance abuse exist,
including risk and resiliency factors that characterize
individuals and groups and their living environments.
3. Describe the behavioral, psychological, physical health, and
social effects of psychoactive substances on the user and
significant others.
4. Recognize the potential for substance use disorders to mimic
a variety of medical and psychological disorders and the
potential for medical and psychological disorders to co-exist
with addiction and substance abuse.
B.
TREATMENT KNOWLEDGE
1. Describe the philosophies, practices, policies, and outcomes
of the most generally accepted and scientifically supported
models of treatment, recovery, relapse prevention, and
continuing care for addiction and other substance-related
problems.
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2. Recognize the importance of family, social networks, and
community systems in the treatment and recovery process.
3. Understand the importance of research and outcome data
and their application in clinical practice.
4. Understand the value of an interdisciplinary approach to
addiction treatment.
C.
APPLICATION TO PRACTICE
1. Understand the established diagnostic criteria for substance
use disorders and describe treatment modalities and
placement criteria within the continuum of care.
2. Describe a variety of helping strategies for reducing the
negative effects of substance use, abuse, and dependence.
3. Tailor helping strategies and treatment modalities to the
client=s stage of dependence, change, or recovery.
4. Provide treatment services appropriate to the personal and
cultural identity and language of the client.
5. Adapt practice to the range of treatment settings and
modalities.
6. Be familiar with medical and pharmacological resources in
the treatment of substance use disorders.
7. Understand the variety of insurance and health maintenance
options available and the importance of helping clients
access those benefits.
8. Recognize that crisis may indicate an underlying substance
use disorder and may be a window of opportunity for change.
D.
9. Understand the need for and the use of methods for
measuring treatment outcome.
PROFESSIONAL READINESS
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1. Understand diverse cultures and incorporate the relevant
needs of culturally diverse groups, as well as people with
disabilities, into clinical practice.
2. Understand the importance of self-awareness in one=s
personal, professional, and cultural life.
3. Understand the addiction professional=s obligations to adhere
to ethical and behavioral standards of conduct in the helping
relationship.
4. Understand the importance of ongoing supervision and
continuing education in the delivery of client services.
5. Understand the obligation of the addiction professional to
participate in prevention as well as treatment.
6. Understand and apply setting-specific policies and
procedures for handling crisis or dangerous situations,
including safety measures for clients and staff.
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Section 2
PROFESSIONAL PRACTICE DIMENSIONS
The basic tasks and responsibilities that constitute the work of an
addiction counselor.
I.
Clinical Evaluation
Screening
Assessment
II.
Treatment Planning
III.
Referral
IV.
Service Coordination
Implementing the Treatment Plan
Consulting
Continuing Assessment and Treatment
Planning
V.
Counseling
Individual Counseling
Group Counseling
Counseling for Families, Couples, and
Significant Others
VI.
Client, Family, and Community Education
VII.
Documentation
VIII. Professional and Ethical Responsibilities
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I.
CLINICAL EVALUATION
The systematic approach to screening and assessment.
A.
SCREENING
The process through which counselor, client and available significant
others determine the most appropriate initial course of action, given
the client's needs and characteristics, and the available resources
within the community.
1. Establish rapport, including management of crisis situation
and determination of need for additional professional
assistance.
2. Gather data systematically from the client and other available
collateral sources, using screening instruments and other
methods that are sensitive to age, developmental level,
culture, and gender. At a minimum, data should include
current and historic substance use; health, mental health,
and substance related treatment history; mental status; and
current social, environmental, and/or economic constraints.
3. Screen for psychoactive substance toxicity, intoxication, and
withdrawal symptoms; aggression or danger to others;
potential for self-inflicted harm or suicide; and coexisting
mental health problems.
4. Assist the client in identifying the impact of substance use on
his or her current life problems and the effects of continued
harmful use or abuse.
5. Determine the client's readiness for treatment and change as
well as the needs of others involved in the current situation.
6. Review the treatment options that are appropriate for the
client's needs, characteristics, goals, and financial resources.
7. Apply accepted criteria for diagnosis of substance use
disorders in making treatment recommendations.
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8. Construct with client and appropriate others an initial action
plan based on client needs, preferences, and resources
available.
9. Based on initial action plan, take specific steps to initiate an
admission or referral and ensure follow-through.
B.
ASSESSMENT
An ongoing process through which the counselor collaborates with the
client and others to gather and interpret information necessary for
planning treatment and evaluating client progress.
1. Select and use a comprehensive assessment process that is
sensitive to age, gender, racial and ethnic cultural issues,
and disabilities that includes, but is not limited to:
- history of alcohol and other drug use;
- physical health, mental health, and addiction treatment
history;
- family issues;
- work history and career issues;
- history of criminality;
- psychological, emotional, and world-view concerns;
- current status of physical health, mental health, and
substance use;
- spirituality;
- education and basic life skills;
- socio-economic characteristics, lifestyle, and current
legal status;
- use of community resources.
2. Analyze and interpret the data to determine treatment
recommendations.
3. Seek appropriate supervision and consultation.
4. Document assessment findings and treatment
recommendations.
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II.
TREATMENT PLANNING
A collaborative process through which the counselor and client
develop desired treatment outcomes and identify the strategies for
achieving them.
At a minimum the treatment plan addresses the identified substance
use disorder(s), as well as issues related to treatment progress,
including relationships with family and significant others, employment,
education, spirituality, health concerns, and legal needs.
1. Obtain and interpret all relevant assessment information.
2. Explain assessment findings to the client and significant
others involved in potential treatment.
3. Provide the client and significant others with clarification and
further information as needed.
4. Examine treatment implications in collaboration with the client
and significant others.
5. Confirm the readiness of the client and significant others to
participate in treatment.
6. Prioritize client needs in the order they will be addressed.
7. Formulate mutually agreed upon and measurable treatment
outcome statements for each need.
8. Identify appropriate strategies for each outcome.
9. Coordinate treatment activities and community resources with
prioritized client needs in a manner consistent with the
client's diagnosis and existing placement criteria.
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10. Develop with the client a mutually acceptable plan of action
and method for monitoring and evaluating progress.
11. Inform client of confidentiality rights, program procedures
that safeguard them, and the exceptions imposed by
regulations.
12. Reassess the treatment plan at regular intervals and/or
when indicated by changing circumstances.
III.
REFERRAL
The process of facilitating the client=s utilization of available support
systems and community resources to meet needs identified in clinical
evaluation and/or treatment planning.
1. Establish and maintain relations with civic groups, agencies,
other professionals, governmental entities, and the
community-at-large to ensure appropriate referrals, identify
service gaps, expand community resources, and help to
address unmet needs.
2. Continuously assess and evaluate referral resources to
determine their appropriateness.
3. Differentiate between situations in which it is most
appropriate for the client to self-refer to a resource and
instances requiring counselor referral.
4. Arrange referrals to other professionals, agencies,
community programs, or other appropriate resources to meet
client needs.
5. Explain in clear and specific language the necessity for and
process of referral to increase the likelihood of client
understanding and follow through.
6. Exchange relevant information with the agency or
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professional to whom the referral is being made in a manner
consistent with confidentiality regulations and generally
accepted professional standards of care.
7. Evaluate the outcome of the referral.
IV.
SERVICE COORDINATION
The administrative, clinical, and evaluative activities that bring the
client, treatment services, community agencies, and other resources
together to focus on issues and needs identified in the treatment plan.
Service coordination, which includes case management and client
advocacy, establishes a framework of action for the client to achieve
specified goals. It involves collaboration with the client and significant
others, coordination of treatment and referral services, liaison
activities with community resources and managed care systems, client
advocacy, and ongoing evaluation of treatment progress and client
needs.
A. IMPLEMENTING THE TREATMENT PLAN
1. Initiate collaboration with referral source.
2. Obtain, review, and interpret all relevant screening,
assessment, and initial treatment-planning information.
3. Confirm the client=s eligibility for admission and continued
readiness for treatment and change.
4. Complete necessary administrative procedures for admission
to treatment.
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5. Establish accurate treatment and recovery expectations with
the client and involved significant others including, but not
limited to:
- nature of services,
- program goals,
- program procedures,
- rules regarding client conduct,
- schedule of treatment activities,
- costs of treatment,
- factors affecting duration of care,
- client rights and responsibilities.
6. Coordinate all treatment activities with services provided to
the client by other resources.
B. CONSULTING
1. Summarize client=s personal and cultural background,
treatment plan, recovery progress, and problems inhibiting
progress for purpose of assuring quality of care, gaining
feedback, and planning changes in the course of treatment.
2. Understand terminology, procedures, and roles of other
disciplines related to the treatment of substance use
disorders.
3. Contribute as part of a multidisciplinary treatment team.
4. Apply confidentiality regulations appropriately.
5. Demonstrate respect and non-judgmental attitudes toward
clients in all contacts with community professionals and
agencies.
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C. CONTINUING ASSESSMENT AND
TREATMENT PLANNING
1. Maintain ongoing contact with client and involved significant
others to ensure adherence to the treatment plan.
2. Understand and recognize stages of change and other signs
of treatment progress.
3. Assess treatment and recovery progress and, in consultation
with the client and significant others, make appropriate
changes to the treatment plan to ensure progress toward
treatment goals.
4. Describe and document treatment process, progress, and
outcome.
5. Use accepted treatment outcome measures.
6. Conduct continuing care, relapse prevention, and discharge
planning with the client and involved significant others.
7. Document service coordination activities throughout the
continuum of care.
8. Apply placement, continued stay, and discharge criteria for
each modality on the continuum of care.
V. COUNSELING
A collaborative process that facilitates the client=s progress toward
mutually determined treatment goals and objectives. Counseling
includes methods that are sensitive to individual client characteristics
and to the influence of significant others, as well as the client=s cultural
and social context. Competence in counseling is built upon an
understanding of, appreciation of, and ability to appropriately use the
contributions of various addiction counseling models as they apply to
modalities of care for individuals, groups, families, couples, and
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significant others.
A. Individual Counseling
1. Establish a helping relationship with the client characterized
by warmth, respect, genuineness, concreteness, and
empathy.
2. Facilitate the client=s engagement in the treatment and
recovery process.
3. Work with the client to establish realistic, achievable goals
consistent with achieving and maintaining recovery.
4. Promote client knowledge, skills, and attitudes that contribute
to a positive change in substance use behaviors.
5. Encourage and reinforce client actions determined to be
beneficial in progressing toward treatment goals.
6. Work appropriately with the client to recognize and
discourage all behaviors inconsistent with progress toward
treatment goals.
7. Recognize how, when, and why to involve the client=s
significant others in enhancing or supporting the treatment
plan.
8. Promote client knowledge, skills, and attitudes consistent
with the maintenance of health and prevention of human
immunodeficiency virus/acquired immune deficiency
syndrome (HIV/AIDS), tuberculosis (TB), sexually
transmitted diseases (STDs), and other infectious diseases.
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9. Facilitate the development of basic and life skills associated
with recovery.
10. Adapt counseling strategies to the individual
characteristics of the client, including but not limited to,
disability, gender, sexual orientation, developmental level,
culture, ethnicity, age, and health status.
11. Make constructive therapeutic responses when client=s
behavior is inconsistent with stated recovery goals.
12. Apply crisis management skills.
13. Facilitate the client=s identification, selection, and practice of
strategies that help sustain the knowledge, skills, and
attitudes needed for maintaining treatment progress and
preventing relapse.
B. GROUP COUNSELING
1. Describe, select, and appropriately use strategies from
accepted and culturally appropriate models for group
counseling with clients with substance use disorders.
2. Carry out the actions necessary to form a group, including,
but not limited to: determining group type, purpose, size, and
leadership; recruiting and selecting members; establishing
group goals and clarifying behavioral ground rules for
participating; identifying outcomes; and determining criteria
and methods for termination or graduation from the group.
3. Facilitate the entry of new members and the transition of
exiting members.
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4. Facilitate group growth within the established ground rules
and movement toward group and individual goals by using
methods consistent with group type.
5. Understand the concepts of process and content, and shift
the focus of the group when such an intervention will help the
group move toward its goals.
6. Describe and summarize client behavior within the group for
the purpose of documenting the client=s progress and
identifying needs and issues that may require a modification
in the treatment plan.
C. COUNSELING FAMILIES, COUPLES, AND
SIGNIFICANT OTHERS
1. Understand the characteristics and dynamics of families,
couples, and significant others affected by substance use.
2. Be familiar with and appropriately use models of diagnosis
and intervention for families, couples, and significant others,
including extended, kinship, or tribal family structures.
3. Facilitate the engagement of selected members of the family,
couple, or significant others in the treatment and recovery
process.
4. Assist families, couples, and significant others to understand
the interaction between the system and substance use
behaviors.
5. Assist families, couples, and significant others to adopt
strategies and behaviors that sustain recovery and maintain
healthy relationships.
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VI. CLIENT, FAMILY, AND COMMUNITY EDUCATION
The process of providing clients, families, significant others, and
community groups with information on risks related to psychoactive
substance use, as well as available prevention, treatment and
recovery resources.
1. Provide culturally relevant formal and informal education
programs that raise awareness and support substance
abuse prevention and/or the recovery process.
2. Describe factors that increase the likelihood for an individual,
community, or group to be at-risk for, or resilient to,
psychoactive substance use disorders.
3. Sensitize others to issues of cultural identity, ethnic
background, age, and gender in prevention, treatment, and
recovery.
4. Describe warning signs, symptoms, and the course of
substance use disorders.
5. Describe how substance use disorders affect families and
concerned others.
6. Describe the continuum of care and resources available to
family and concerned others.
7. Describe principles and philosophy of prevention, treatment,
and recovery.
8. Understand and describe the health and behavior problems
related to substance use, including transmission and
prevention of HIV/AIDS, TB, STDs, and other infectious
diseases.
9. Teach life skills, including but not limited to, stress
management, relaxation, communication, assertiveness, and
refusal skills.
VII. DOCUMENTATION
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The recording of the screening and intake process, assessment,
treatment plan, clinical reports, clinical progress notes, discharge
summaries, and other client-related data.
1. Demonstrate knowledge of accepted principles of client
record management.
2. Protect client rights to privacy and confidentiality in the
preparation and handling of records, especially in relation to
the communication of client information with third parties.
3. Prepare accurate and concise screening, intake, and
assessment reports.
4. Record treatment and continuing care plans that are
consistent with agency standards and comply with applicable
administrative rules.
5. Record progress of client in relation to treatment goals and
objectives.
6. Prepare accurate and concise discharge summaries.
7. Document treatment outcome, using accepted methods and
instruments.
VIII. PROFESSIONAL AND ETHICAL RESPONSIBILITIES
The obligations of an addiction counselor to adhere to accepted
ethical and behavioral standards of conduct and continuing
professional development.
1. Adhere to established professional codes of ethics that
define the professional context within which the counselor
works, in order to maintain professional standards and
safeguard the client.
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2. Adhere to Federal and State laws and agency regulations
regarding the treatment of substance use disorders.
3. Interpret and apply information from current counseling and
psychoactive substance use research literature to improve
client care and enhance professional growth.
4. Recognize the importance of individual differences that
influence client behavior and apply this understanding to
clinical practice.
5. Utilize a range of supervisory options to process personal
feelings and concerns about clients.
6. Conduct self-evaluations of professional performance
applying ethical, legal, and professional standards to
enhance self-awareness and performance.
7. Obtain appropriate continuing professional education.
8. Participate in ongoing supervision and consultation.
9. Develop and utilize strategies to maintain one=s own physical
and mental health.
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